Provider Demographics
NPI:1437435682
Name:BUDA, KATHLEEN SULLIVAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SULLIVAN
Last Name:BUDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH ST
Mailing Address - Street 2:SOUTH SIDE SCHOOL
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-1511
Mailing Address - Country:US
Mailing Address - Phone:315-697-6362
Mailing Address - Fax:315-697-6368
Practice Address - Street 1:200 HIGH ST
Practice Address - Street 2:SOUTH SIDE SCHOOL
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-1511
Practice Address - Country:US
Practice Address - Phone:315-697-6362
Practice Address - Fax:315-697-6368
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338135163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse