Provider Demographics
NPI:1861006397
Name:TUDEE, EDDINGTON H BOBBY (RN)
Entity Type:Individual
Prefix:MR
First Name:EDDINGTON
Middle Name:H BOBBY
Last Name:TUDEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16313 50TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3667
Mailing Address - Country:US
Mailing Address - Phone:612-840-9750
Mailing Address - Fax:
Practice Address - Street 1:725 2ND AVE S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7782
Practice Address - Country:US
Practice Address - Phone:952-935-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74363LF0000X
MN2097642163W00000X
MN7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse