Healthcare Provider Details

I. General information

NPI: 1720157589
Provider Name (Legal Business Name): PATRICIA E BULS APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISH BULS APRN BC

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MAIN ST
LEWISTON ME
04240
US

IV. Provider business mailing address

460 MAIN ST
LEWISTON ME
04240
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-5731
  • Fax: 207-784-2232
Mailing address:
  • Phone: 207-782-5731
  • Fax: 207-784-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS84136
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: