Healthcare Provider Details

I. General information

NPI: 1912056482
Provider Name (Legal Business Name): CAROL MARIE BUDGIN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FIR ST STE 320
EAST CHICAGO IN
46312-3076
US

IV. Provider business mailing address

4320 FIR ST STE 320
EAST CHICAGO IN
46312-3076
US

V. Phone/Fax

Practice location:
  • Phone: 219-554-4080
  • Fax: 219-554-4085
Mailing address:
  • Phone: 219-554-4080
  • Fax: 219-554-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number28083700A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: