Provider Demographics
NPI:1689394074
Name:HUDSON, ENOCH AMANI
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:AMANI
Last Name:HUDSON
Suffix:
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 1:5950 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-9498
Mailing Address - Country:US
Mailing Address - Phone:651-444-0434
Mailing Address - Fax:
Practice Address - Street 1:5950 OAK ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9498
Practice Address - Country:US
Practice Address - Phone:651-444-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver