MEDICARE: PHILLIP WADE BULLINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN200299	AZ
2	367500000X	Certified Registered Nurse Anesthetist	294037	AZ

General Provider Information

NPI Number	:	1942812359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP WADE BULLINGTON

Provider Business Mailing Address
First Line	:	6437 S WOODLAND HILLS DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5976
Country	:	US
Telephone Number	:	520-954-1403
Fax Number	:

Provider Business Practice Location Address
First Line	:	6437 S WOODLAND HILLS DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5976
Country	:	US
Telephone Number	:	520-954-1403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	07/03/2023

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Directions to “ PHILLIP WADE BULLINGTON ” Practice Location

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