Healthcare Provider Details

I. General information

NPI: 1558941559
Provider Name (Legal Business Name): MAUREEN CHRISTINE BULLEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 HILLSIDE AVE
JAMAICA NY
11432-5773
US

IV. Provider business mailing address

17520 HILLSIDE AVE
JAMAICA NY
11432-5773
US

V. Phone/Fax

Practice location:
  • Phone: 718-558-7230
  • Fax: 718-658-7230
Mailing address:
  • Phone: 718-558-7230
  • Fax: 718-658-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number433371-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: