Provider Demographics
NPI:1770705592
Name:LABUDDE, LAURIE ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN
Last Name:LABUDDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CROSS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4362
Mailing Address - Country:US
Mailing Address - Phone:619-922-2579
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 8 DOGWOOD AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2828
Practice Address - Fax:423-979-2829
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X
TNAPN0000025679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman