MRS. THERESA SUE IGNACZAK BULLIS CPNP-PC NPI 1871041996

NPI Information

NPI: 1871041996
Provider Name: MRS. THERESA SUE IGNACZAK BULLIS, CPNP-PC
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

Address:
4855 S MOORLAND RD
NEW BERLIN, WI
ZIP 53151
Phone: (262) 432-7599
Get Directions

MRS. Theresa Sue Ignaczak Bullis, CPNP-PC is a pediatrics nurse practitioner in New Berlin, WI. MRS. Theresa Sue Ignaczak Bullis, CPNP-PC NPI is 1871041996. 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:

4855 S MOORLAND RD
NEW BERLIN, WI
ZIP 53151-494
Phone: (262) 432-7599
Fax: (262) 432-7694

The enumeration date for this NPI number is 9/18/2016 and was last updated on 12/17/2018.

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	363LP0200X	Nurse Practitioner	Pediatrics	7248-33	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	1871041996	MEDICAID	WISCONSIN

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: 5/5/2024

NPI Synchronization or Removal

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