Provider Demographics
NPI:1962780783
Name:BUDRECK, ASHLEY DANIELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:BUDRECK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:DANIELLE
Other - Last Name:BERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:N1537 OAK ST.
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1902
Mailing Address - Country:US
Mailing Address - Phone:262-758-9663
Mailing Address - Fax:
Practice Address - Street 1:N1537 OAK ST.
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1902
Practice Address - Country:US
Practice Address - Phone:262-758-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI185413-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100017252Medicaid