Provider Demographics
NPI:1285190132
Name:OMWERI, HUDSON M (CNP)
Entity Type:Individual
Prefix:
First Name:HUDSON
Middle Name:M
Last Name:OMWERI
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:OGILVIE
Mailing Address - State:MN
Mailing Address - Zip Code:56358-9005
Mailing Address - Country:US
Mailing Address - Phone:612-799-7564
Mailing Address - Fax:
Practice Address - Street 1:1621 HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:OGILVIE
Practice Address - State:MN
Practice Address - Zip Code:56358-9005
Practice Address - Country:US
Practice Address - Phone:612-799-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6444363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care