Provider Demographics
NPI:1063843704
Name:BUDROW, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BUDROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 COLUMBIA AVE.
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1331
Mailing Address - Country:US
Mailing Address - Phone:608-846-9392
Mailing Address - Fax:
Practice Address - Street 1:436 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1331
Practice Address - Country:US
Practice Address - Phone:608-846-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156885-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health