Healthcare Provider Details

I. General information

NPI: 1609812288
Provider Name (Legal Business Name): JOANNE E BULLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COURT STREET
KEENE NH
03431-1719
US

IV. Provider business mailing address

590 COURT ST
KEENE NH
03431-1719
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5400
  • Fax: 603-354-6645
Mailing address:
  • Phone: 603-354-5400
  • Fax: 603-354-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7168
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: