MARCELLE BULLARD PA NPI 1184722001

NPI Information

NPI: 1184722001
Provider Name: MARCELLE BULLARD, PA
Classification: Physician Assistant - 363A00000X
Entity Type: Individual
PECOS Registration: Yes
Address: 14555 W NATIONAL AVE
NEW BERLIN, WI
ZIP 53151
Phone: (262) 827-3636

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NPI Details

Marcelle Bullard, PA is a physician assistant in New Berlin, WI. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Marcelle Bullard, PA NPI is 1184722001. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

14555 W NATIONAL AVE
NEW BERLIN, WI
ZIP 53151-494
Phone: (262) 827-3636

The NPI 1184722001 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/21/2006 and was last updated on 11/29/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	085-002401	ILLINOIS	No
2	363A00000X	Physician Assistant		3485-023	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100043751	MEDICAID	WISCONSIN
2	085-002401	OTHER	ILLINOIS	IL STATE LIC
3	385-001224	OTHER	ILLINOIS	IL CONTROL SUBSTANCE LIC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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