Healthcare Provider Details

I. General information

NPI: 1407840507
Provider Name (Legal Business Name): ROWENA O BULLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W ILLINOIS AVE
MIDLAND TX
79701-6407
US

IV. Provider business mailing address

PO BOX 5718
NORMAN OK
73070-5718
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-1111
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP113552
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP113552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: