Provider Demographics
NPI:1023073608
Name:HUDSON, MARNIE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MARNIE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1400
Mailing Address - Country:US
Mailing Address - Phone:434-947-3920
Mailing Address - Fax:434-947-3924
Practice Address - Street 1:2138 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1400
Practice Address - Country:US
Practice Address - Phone:434-947-3920
Practice Address - Fax:434-947-3924
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01124363A00000X
VA0110002473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023073608Medicaid
WVHUPA24511Medicare ID - Type Unspecified
VAVV4952A696Medicare PIN
WVQ38185Medicare UPIN