Provider Demographics
NPI:1508199209
Name:BUDRUS, CAREY ELLEN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:ELLEN
Last Name:BUDRUS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8258
Mailing Address - Country:US
Mailing Address - Phone:513-282-3010
Mailing Address - Fax:513-282-3011
Practice Address - Street 1:1425 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8258
Practice Address - Country:US
Practice Address - Phone:513-282-3010
Practice Address - Fax:513-282-3011
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10965-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3095850Medicaid