MEDICARE: DIANE M BUDNICK CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R1642632	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144287251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M BUDNICK CNP

Provider Business Mailing Address
First Line	:	2104 NORTHDALE BLVD NW
Second Line	:	SUITE 220 MEDICAL ADVANCED PAIN SPECIALISTS
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55433-3028
Country	:	US
Telephone Number	:	763-537-6000
Fax Number	:	763-537-6666

Provider Business Practice Location Address
First Line	:	1700 UNIVERSITY AVE W
Second Line	:	MEDICAL ADVANCED PAIN SPECIALISTS
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:	763-537-6000
Fax Number	:	763-537-6666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	06/03/2022

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