Bullis, Theresa Sue Ignaczak

Bullis, Theresa Sue Ignaczak is an individual health care provider with primary practice located at 4855 S Moorland Rd , New Berlin WI 53151-7494. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Bullis, Theresa Sue Ignaczak can be contacted via phone (262) 432-7599.

Contact Information

Primary practice address
4855 S Moorland Rd New Berlin WI 53151-7494
Phone: (262) 432-7599
Fax: (262) 432-7694
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 7248-33 Wisconsin

Profile Details

NPI number 1871041996
LBN Legal business name Bullis, Theresa Sue Ignaczak
Credentials CPNP-PC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 18th, 2016
Last updated Dec 17th, 2018 - about 7 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 1871041996 NPPES
Wisconsin MEDICAID 1871041996

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