Healthcare Provider Details

I. General information

NPI: 1730742719
Provider Name (Legal Business Name): PAUL ANTHONY BUDNY APRN-FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 SCIENCE PARK DR STE 210
BEACHWOOD OH
44122-7328
US

IV. Provider business mailing address

800 BATES RD
ROCKY RIVER OH
44116-2167
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax: 216-450-1614
Mailing address:
  • Phone: 216-403-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.214293
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.024924
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024924
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: