Individual
LEISHA BULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4924
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
714121
TX
Other
Enumeration date
04/01/2014
Last updated
04/01/2014
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