Provider Demographics
NPI:1972127645
Name:HUDSON-DOUGLAS, DIONE SAMANTHA (NP)
Entity type:Individual
Prefix:
First Name:DIONE
Middle Name:SAMANTHA
Last Name:HUDSON-DOUGLAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5231
Mailing Address - Country:US
Mailing Address - Phone:845-294-1234
Mailing Address - Fax:845-294-7583
Practice Address - Street 1:1995 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5231
Practice Address - Country:US
Practice Address - Phone:845-294-1234
Practice Address - Fax:845-294-7583
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308446363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health