Provider Demographics
NPI:1164569315
Name:BUDREAU, KRISTEEN LEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEEN
Middle Name:LEE
Last Name:BUDREAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6639 161ST AVE SE
Mailing Address - Street 2:UNIT B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5687
Mailing Address - Country:US
Mailing Address - Phone:616-328-1190
Mailing Address - Fax:
Practice Address - Street 1:6639 161ST AVE SE
Practice Address - Street 2:UNIT B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5687
Practice Address - Country:US
Practice Address - Phone:616-328-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant