Healthcare Provider Details

I. General information

NPI: 1710891981
Provider Name (Legal Business Name): ERIC HUDNALL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 N WATER ST APT 1525
MILWAUKEE WI
53202-1727
US

IV. Provider business mailing address

1785 N WATER ST APT 1525
MILWAUKEE WI
53202-1727
US

V. Phone/Fax

Practice location:
  • Phone: 386-785-3398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number112131130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: