Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60033486 | WA |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP60033486 | WA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP60033486 | WA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP60033486 | WA |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP60033486 | WA |
NPI | 1609956150 |
---|---|
Provider Name | Kenda Dee Bulley |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 10/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124770 | L & I (01) | VA |
9630807 | (05) | WA |