Provider Demographics
NPI:1932734597
Name:BUDDE, LAURA (DNP, APRN, A-GNP-C)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:BUDDE
Suffix:
Gender:F
Credentials:DNP, APRN, A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3752 PARK BLVD APT 501
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3782
Mailing Address - Country:US
Mailing Address - Phone:319-361-1811
Mailing Address - Fax:
Practice Address - Street 1:880 3RD AVE STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1305
Practice Address - Country:US
Practice Address - Phone:619-205-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128536163WC0200X
IAH159550363LA2200X, 363LG0600X, 363LP2300X
CA95015208363LA2200X, 363LP2300X, 363LG0600X
CA95225993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse