Provider Demographics
NPI:1528053576
Name:BUDURA, BONITA L (CRNA)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:L
Last Name:BUDURA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6609
Mailing Address - Country:US
Mailing Address - Phone:610-433-3644
Mailing Address - Fax:
Practice Address - Street 1:525 S 25TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6609
Practice Address - Country:US
Practice Address - Phone:610-433-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN197291L163W00000X
PA047724367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1463827OtherHIGHMARK
PA1463827OtherHIGHMARK
PA430080402Medicare PIN
PA113686Medicare PIN