Provider Demographics
NPI:1447506936
Name:BUDDENHAGEN, JEFFREY WILLIAM II (LPN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:BUDDENHAGEN
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2507
Mailing Address - Country:US
Mailing Address - Phone:315-223-1428
Mailing Address - Fax:
Practice Address - Street 1:21 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-2507
Practice Address - Country:US
Practice Address - Phone:315-223-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306607-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse