Provider Demographics
NPI:1265907083
Name:BUDD, LILLIA (CNP)
Entity type:Individual
Prefix:
First Name:LILLIA
Middle Name:
Last Name:BUDD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E NICOLLET BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6735
Mailing Address - Country:US
Mailing Address - Phone:612-269-3929
Mailing Address - Fax:
Practice Address - Street 1:225 SMITH AVE N - SUITE 400
Practice Address - Street 2:MAIL ROUTE 65400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-241-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily