MEDICARE: MRS. JENNIFER HUDKINS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LN85394	MA
2	164W00000X	Licensed Practical Nurse	031410	CT

General Provider Information

NPI Number	:	1205155140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER HUDKINS LPN

Provider Business Mailing Address
First Line	:	63 SISSON ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1537
Country	:	US
Telephone Number	:	860-906-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 SISSON ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1537
Country	:	US
Telephone Number	:	860-906-8966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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