Provider Demographics
NPI:1801436274
Name:BUDIG, SUSAN RANEA (FNP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RANEA
Last Name:BUDIG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:475 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1759
Mailing Address - Country:US
Mailing Address - Phone:307-235-9340
Mailing Address - Fax:307-237-2036
Practice Address - Street 1:1514 E 12TH ST # 210
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4084
Practice Address - Country:US
Practice Address - Phone:307-235-6116
Practice Address - Fax:307-235-0249
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY45200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1851410682Medicaid