Individual
LISA L BULTHUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 FODEN RD, WEST, SUITE 100, SOUTH PORTLAND, ME 04106
(207) 523-3904
(207) 523-8588
Mailing address
100 GANNETT DRIVE, SUITE C, SOUTH PORTLAND, ME 04106
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP81553
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E400409706
MEDICARE
ME
01
—
E400409710
MEDICARE
ME
Enumeration date
04/05/2006
Last updated
11/07/2017
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