Provider Demographics
NPI:1114983855
Name:HUDSON, DEBRA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S79W31625 SUGDEN RD
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9394
Mailing Address - Country:US
Mailing Address - Phone:262-363-4463
Mailing Address - Fax:
Practice Address - Street 1:S79W31625 SUGDEN RD
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9394
Practice Address - Country:US
Practice Address - Phone:262-363-4463
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23769-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse