Provider Demographics
NPI:1023632023
Name:HUDSON, SANDRA CLARE (RN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CLARE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92088-1322
Mailing Address - Country:US
Mailing Address - Phone:760-468-4453
Mailing Address - Fax:
Practice Address - Street 1:2111 MISSION AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-2395
Practice Address - Country:US
Practice Address - Phone:760-901-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCS00042F302F00000X
CA399426163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No302F00000XManaged Care OrganizationsExclusive Provider Organization