Individual
REGINA HUDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S 11TH ST, SUITE 1950, PHILADELPHIA, PA 19107-4824
(215) 955-9207
Mailing address
111 S 11TH ST, SUITE 1950 GIBBONE, PHILADELPHIA, PA 19107-4824
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP011942
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103088580
—
PA
Enumeration date
04/04/2012
Last updated
05/03/2016
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