=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912592908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE BUDKE RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2021
-----------------------------------------------------
Last Update Date | 03/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MINNESOTA AVE
-----------------------------------------------------
City | BRECKENRIDGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56520-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-643-3871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 MINNESOTA AVE
-----------------------------------------------------
City | BRECKENRIDGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56520-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-643-3871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | R47665
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2476535
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------