=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508199209
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAREY ELLEN BUDRUS NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2009
-----------------------------------------------------
Last Update Date | 02/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 COLUMBUS AVE
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45036-8258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-282-3010
-----------------------------------------------------
Fax | 513-282-3011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1425 COLUMBUS AVE
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45036-8258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-282-3010
-----------------------------------------------------
Fax | 513-282-3011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | COA.10965-NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------