Provider Demographics
NPI:1174260996
Name:HUDSON, JEREMIAH LORENZE I
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:LORENZE
Last Name:HUDSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3772 HAYES ST NE APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1737
Mailing Address - Country:US
Mailing Address - Phone:202-277-7270
Mailing Address - Fax:
Practice Address - Street 1:3778 HAYES ST NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1740
Practice Address - Country:US
Practice Address - Phone:202-509-2625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant