Healthcare Provider Details

I. General information

NPI: 1477946051
Provider Name (Legal Business Name): LINDSEY BULGRIEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 BLACK RIVER ST
DECKERVILLE MI
48427-9425
US

IV. Provider business mailing address

3559 PINE ST PO BOX 126
DECKERVILLE MI
48427-7703
US

V. Phone/Fax

Practice location:
  • Phone: 810-376-2885
  • Fax: 810-376-8301
Mailing address:
  • Phone: 810-376-2885
  • Fax: 810-376-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704253199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: