Provider Demographics
NPI:1457089385
Name:BUDELL, ANGIE (HHP)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:BUDELL
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14348 S HERRIMAN VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5785
Mailing Address - Country:US
Mailing Address - Phone:801-694-7261
Mailing Address - Fax:
Practice Address - Street 1:14348 S HERRIMAN VIEW WAY
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-5785
Practice Address - Country:US
Practice Address - Phone:801-694-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT219583902133NN1002X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT219583902Medicaid