Provider Demographics
NPI:1073807046
Name:BUDD, STEPHANIE MARY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARY
Last Name:BUDD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 LAROE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-2439
Mailing Address - Country:US
Mailing Address - Phone:845-469-4538
Mailing Address - Fax:
Practice Address - Street 1:636 LAROE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-2439
Practice Address - Country:US
Practice Address - Phone:845-469-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210444-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse