Individual
LISA MARIE BULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APNP
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-0728
(414) 805-4606
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-0728
(414) 805-4606
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
195913-30
WI
363L00000X
Nurse Practitioner
Primary
9484
WI
363LA2100X
Acute Care Nurse Practitioner
9484-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092474
—
WI
01
—
195913-30
WISCONSIN STATE BOARD OF NURSING
WI
01
—
9484-33
THE STATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
Enumeration date
06/21/2019
Last updated
07/19/2021
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