Provider Demographics
NPI:1952172306
Name:WARDERE, HUDA
Entity Type:Individual
Prefix:
First Name:HUDA
Middle Name:
Last Name:WARDERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 SLOAN PL STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2085
Mailing Address - Country:US
Mailing Address - Phone:651-797-4821
Mailing Address - Fax:
Practice Address - Street 1:1973 SLOAN PL STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2085
Practice Address - Country:US
Practice Address - Phone:651-797-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2500121163W00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163W00000XNursing Service ProvidersRegistered Nurse