Provider Demographics
NPI:1972924900
Name:BUDHAN, MANPREET KAUR (NP)
Entity type:Individual
Prefix:MRS
First Name:MANPREET
Middle Name:KAUR
Last Name:BUDHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12774 BOENKER LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2436
Mailing Address - Country:US
Mailing Address - Phone:314-291-7997
Mailing Address - Fax:314-739-1471
Practice Address - Street 1:12776 BOENKER LN
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2436
Practice Address - Country:US
Practice Address - Phone:314-291-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013040394363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health