Healthcare Provider Details

I. General information

NPI: 1982369161
Provider Name (Legal Business Name): LISA MARIE VOLPENHEIN-BULLUCKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE VOLPENHEIN

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MADISON AVE
COVINGTON KY
41014-1210
US

IV. Provider business mailing address

2002 MADISON AVE
COVINGTON KY
41014-1210
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-3345
  • Fax: 859-655-6374
Mailing address:
  • Phone: 859-431-3345
  • Fax: 859-655-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015891
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: