Healthcare Provider Details

I. General information

NPI: 1801703871
Provider Name (Legal Business Name): BULIN PMHNP HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 W MASON ST STE 200
GREEN BAY WI
54303-2049
US

IV. Provider business mailing address

5768 ACACIA LN
LAKEWOOD CA
90712-1283
US

V. Phone/Fax

Practice location:
  • Phone: 612-387-2821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALICIA BULIN
Title or Position: CEO
Credential: NP
Phone: 612-387-2821