Healthcare Provider Details

I. General information

NPI: 1750905410
Provider Name (Legal Business Name): ANNET NAMUJJU BUKULU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 EVERETT AVE STE 12
CHELSEA MA
02150-2317
US

IV. Provider business mailing address

4541 POINT ROCK DR
BUFORD GA
30519-3862
US

V. Phone/Fax

Practice location:
  • Phone: 857-422-4361
  • Fax:
Mailing address:
  • Phone: 857-417-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN273344
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2303691
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: