Provider Demographics
NPI:1144287251
Name:BUDNICK, DIANE M (CNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:BUDNICK
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Gender:F
Credentials:CNP
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Mailing Address - Street 1:2104 NORTHDALE BLVD NW
Mailing Address - Street 2:SUITE 220 MEDICAL ADVANCED PAIN SPECIALISTS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3028
Mailing Address - Country:US
Mailing Address - Phone:763-537-6000
Mailing Address - Fax:763-537-6666
Practice Address - Street 1:1700 UNIVERSITY AVE W
Practice Address - Street 2:MEDICAL ADVANCED PAIN SPECIALISTS
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3727
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:763-537-6666
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-06-03
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Provider Licenses
StateLicense IDTaxonomies
MNR1642632363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN542490900Medicaid
MN50002799Medicare ID - Type Unspecified
MN542490900Medicaid