Provider Demographics
NPI:1528757895
Name:BUDUL, NASRA D
Entity type:Individual
Prefix:
First Name:NASRA
Middle Name:D
Last Name:BUDUL
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 1:2438 POND AVE E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-6768
Mailing Address - Country:US
Mailing Address - Phone:651-434-5553
Mailing Address - Fax:
Practice Address - Street 1:1 MENDOTA RD W
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-4764
Practice Address - Country:US
Practice Address - Phone:651-554-6100
Practice Address - Fax:651-554-6130
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker