Healthcare Provider Details

I. General information

NPI: 1811592942
Provider Name (Legal Business Name): MATTHEW KEITH BUDD MSN, RN, AGCNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 LANSING AVE
JACKSON MI
49202-2192
US

IV. Provider business mailing address

844 BUSH ST
JACKSON MI
49202-3237
US

V. Phone/Fax

Practice location:
  • Phone: 517-937-4937
  • Fax:
Mailing address:
  • Phone: 517-745-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704292721
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: