Provider Demographics
NPI:1255052379
Name:BUDELL, BRIANA RAE (LPN)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:RAE
Last Name:BUDELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:RAE
Other - Last Name:VRBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 W FORT STEET
Mailing Address - Street 2:BUILDING 28 ROOM G05
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-422-1000
Mailing Address - Fax:
Practice Address - Street 1:500 W FORT STEET
Practice Address - Street 2:BUILDING 28 ROOM G05
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-422-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201507682LPN164W00000X
ID15760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse