Individual
MARCELLE BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
14555 W NATIONAL AVE, NEW BERLIN, WI 53151-4494
(262) 827-3636
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(143) 892-3774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3485-023
WI
363AS0400X
Surgical Physician Assistant
085-002401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002401
IL STATE LIC
IL
05
—
100043751
—
WI
01
—
385-001224
IL CONTROL SUBSTANCE LIC
IL
Enumeration date
09/21/2006
Last updated
11/29/2021
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