Healthcare Provider Details

I. General information

NPI: 1407464910
Provider Name (Legal Business Name): BETH BUDESHEIM LMT, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DE MONTE REY STE B2
SANTA FE NM
87505-3961
US

IV. Provider business mailing address

1456 AVENIDA DE LAS AMERICA APT D
SANTA FE NM
87507-5185
US

V. Phone/Fax

Practice location:
  • Phone: 816-305-4670
  • Fax:
Mailing address:
  • Phone: 816-305-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberR63701
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7005
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: