MEDICARE: FTE-HUDANI ACHINGE

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	363L00000X	Nurse Practitioner	13058	MN
2	208D00000X	General Practice Physician	13058	MN

General Provider Information

NPI Number	:	1790631844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FTE-HUDANI ACHINGE

Provider Business Mailing Address
First Line	:	PO BOX 17370
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-0370
Country	:	US
Telephone Number	:	507-721-9629
Fax Number	:

Provider Business Practice Location Address
First Line	:	P.O BOX 17370 LOT #5124
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-0370
Country	:	US
Telephone Number	:	507-721-9629
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ FTE-HUDANI ACHINGE ” Practice Location

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