Provider Demographics
NPI:1912056482
Name:BUDGIN, CAROL MARIE (CNS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:BUDGIN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 FIR ST
Mailing Address - Street 2:STE 320
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3076
Mailing Address - Country:US
Mailing Address - Phone:219-554-4080
Mailing Address - Fax:219-554-4085
Practice Address - Street 1:4320 FIR ST
Practice Address - Street 2:STE 320
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3076
Practice Address - Country:US
Practice Address - Phone:219-554-4080
Practice Address - Fax:219-554-4085
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28083700A364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200067750AMedicaid
IN28083700AOtherSTATE LICENSE
IN200067750CMedicaid
Q78345Medicare UPIN
IN409080LMedicare PIN
INQ78345Medicare UPIN
IN200067750CMedicaid