Provider Demographics
NPI:1902663792
Name:BUDAGHER-MARSHALL, MIRANDA (DN)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:BUDAGHER-MARSHALL
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 WOODFORD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1225
Mailing Address - Country:US
Mailing Address - Phone:505-264-8395
Mailing Address - Fax:
Practice Address - Street 1:5800 MCLEOD RD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2467
Practice Address - Country:US
Practice Address - Phone:505-550-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDN2024-0004172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath