Healthcare Provider Details

I. General information

NPI: 1881862860
Provider Name (Legal Business Name): KARLA BULLEN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 CANYON RD E
PUYALLUP WA
98371-6302
US

IV. Provider business mailing address

14301 25TH AVENUE CT E
TACOMA WA
98445-4923
US

V. Phone/Fax

Practice location:
  • Phone: 253-230-9845
  • Fax: 253-537-8504
Mailing address:
  • Phone: 253-230-9845
  • Fax: 253-537-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA00017611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: