Provider Demographics
NPI:1033878004
Name:BOKI, BULLI (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:BULLI
Middle Name:
Last Name:BOKI
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10877 TYLER CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3376
Mailing Address - Country:US
Mailing Address - Phone:651-497-1811
Mailing Address - Fax:
Practice Address - Street 1:10877 TYLER CT NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3376
Practice Address - Country:US
Practice Address - Phone:651-497-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2460149163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice