Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 28635 | WI |
NPI | 1003831991 |
---|---|
Provider Name | Rebecca Bull |
First Address | Madison, WI 53717-1941 |
Second Address | Madison, WI 53703-2637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 24/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31521400 | (05) | WI |
E44014 | (02) | WI |