Provider Demographics
NPI:1306488994
Name:HUDSON, TALEESHA JUANITA
Entity type:Individual
Prefix:
First Name:TALEESHA
Middle Name:JUANITA
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 TALBERT ST SE APT 207
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5824
Mailing Address - Country:US
Mailing Address - Phone:202-971-5436
Mailing Address - Fax:
Practice Address - Street 1:1204 TALBERT ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5803
Practice Address - Country:US
Practice Address - Phone:202-492-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14673374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide