Provider Demographics
NPI:1043985559
Name:BULLERT, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BULLERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0109
Mailing Address - Country:US
Mailing Address - Phone:701-740-0427
Mailing Address - Fax:
Practice Address - Street 1:308 GREAT NORTHERN
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-4226
Practice Address - Country:US
Practice Address - Phone:701-740-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide