Provider Demographics
NPI:1043932353
Name:BULL, MERCEDES ANN (APRN)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:ANN
Last Name:BULL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 N MAIN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5772
Mailing Address - Country:US
Mailing Address - Phone:702-336-9877
Mailing Address - Fax:
Practice Address - Street 1:1520 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3336
Practice Address - Country:US
Practice Address - Phone:702-336-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID70256163W00000X, 363LA2200X
NVRN87902163W00000X
WARN61249376163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse