Provider Demographics
NPI:1558941559
Name:BULLEN, MAUREEN CHRISTINE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MAUREEN
Middle Name:CHRISTINE
Last Name:BULLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17520 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5773
Mailing Address - Country:US
Mailing Address - Phone:718-558-7230
Mailing Address - Fax:718-658-7230
Practice Address - Street 1:17520 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5773
Practice Address - Country:US
Practice Address - Phone:718-558-7230
Practice Address - Fax:718-658-7230
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433371-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse