Bullard, Marcelle

Bullard, Marcelle is an individual health care provider with primary practice located at 14555 W National Ave , New Berlin WI 53151-4494. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Bullard, Marcelle can be contacted via phone (262) 827-3636.

Contact Information

Primary practice address
14555 W National Ave New Berlin WI 53151-4494
Phone: (262) 827-3636
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 085-002401 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 3485-023 Wisconsin

Profile Details

NPI number 1184722001
LBN Legal business name Bullard, Marcelle
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2006
Last updated Nov 29th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184722001 NPPES
Illinois Other 385-001224 IL CONTROL SUBSTANCE LIC
Illinois MEDICAID 100043751 IL CONTROL SUBSTANCE LIC
Illinois Other 085-002401 IL CONTROL SUBSTANCE LIC

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