Basic Information
| Provider Information | |||||||||
| NPI: | 1861006397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUDEE | ||||||||
| FirstName: | EDDINGTON | ||||||||
| MiddleName: | H. BOBBY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16313 50TH AVE N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554463667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128409750 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 725 2ND AVE S | ||||||||
| Address2: | |||||||||
| City: | HOPKINS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553437782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529353338 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 74 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 2097642 | MN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 7 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.