Provider Demographics
NPI:1366772956
Name:HUDSON, DANIELLE MARIE (CRNP)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:MARIE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:DINSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2025 CHANEYVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-4300
Mailing Address - Country:US
Mailing Address - Phone:410-286-3865
Mailing Address - Fax:410-286-8085
Practice Address - Street 1:2025 CHANEYVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-4300
Practice Address - Country:US
Practice Address - Phone:410-286-3865
Practice Address - Fax:410-286-8085
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0457345Medicaid
MDN70808OtherCONTROLLED DANGEROUS SUBSTANCE (CDS)