Provider Demographics
NPI:1063044949
Name:HUDECHEK, DAREN I (LPN)
Entity type:Individual
Prefix:
First Name:DAREN
Middle Name:
Last Name:HUDECHEK
Suffix:I
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:DAREN
Other - Middle Name:
Other - Last Name:HUDECHEK
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:8364 ROLYAT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N BELL AVE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-4301
Practice Address - Country:US
Practice Address - Phone:313-409-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703121111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse