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Individual

MARY KAY BULTMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
1020 N 12TH ST FL 4, MILWAUKEE, WI 53233-1308
(414) 219-2000
(414) 219-7402
Mailing address
1020 N 12TH ST FL 4, MILWAUKEE, WI 53233-1308
(414) 219-2000
(414) 219-7402

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
7252
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
60996-30
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100062610
WI
05
100080285
WI
Enumeration date
09/14/2016
Last updated
03/06/2020
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