Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD071008L | PA |
NPI | 1033159017 |
---|---|
Provider Name | Dr. Jennifer Louise Bulger |
First Address | Bear Lake, PA 16402-9602 |
Second Address | Erie, PA 16504-1559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |