Provider Demographics
NPI:1598914251
Name:HUDSON, LAURA CHERYL
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CHERYL
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:DANDREA
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1809 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3069
Mailing Address - Country:US
Mailing Address - Phone:301-390-3128
Mailing Address - Fax:301-390-2390
Practice Address - Street 1:1809 PEACHTREE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3069
Practice Address - Country:US
Practice Address - Phone:301-390-3128
Practice Address - Fax:301-390-2390
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 156FX1800X, 302F00000X, 172A00000X, 235500000X, 225200000X, 133N00000X, 246Z00000X, 251E00000X, 332B00000X, 343900000X
MSH426219028183700000X
VAH426219028DON146N00000X
MS251E00000X
MDH426219028347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No183700000XPharmacy Service ProvidersPharmacy Technician
No172A00000XOther Service ProvidersDriver
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No251E00000XAgenciesHome Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle