MEDICARE: JAMIE BUDD

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.026350	OH

General Provider Information

NPI Number	:	1356975759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE BUDD

Provider Business Mailing Address
First Line	:	3116 STEEPLE CHASE LN
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-6900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3818
Country	:	US
Telephone Number	:	419-291-3900
Fax Number	:

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

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	03/11/2020

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