Provider Demographics
NPI:1548283534
Name:BUDDENSIEK, JENNIFER VILJASTE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:VILJASTE
Last Name:BUDDENSIEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:VILJASTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3623 KREY AVE
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7037
Mailing Address - Country:US
Mailing Address - Phone:651-487-1021
Mailing Address - Fax:
Practice Address - Street 1:920 E 28TH ST STE 190
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1191
Practice Address - Country:US
Practice Address - Phone:612-863-1893
Practice Address - Fax:612-863-3809
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine