Healthcare Provider Details

I. General information

NPI: 1104996578
Provider Name (Legal Business Name): RUTH ANN BUDD NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE NICU
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

4951 64TH ST NE
YORK ND
58386-9304
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7032
  • Fax:
Mailing address:
  • Phone: 701-592-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR 146399-2
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR22495
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: