Provider Demographics
NPI:1568857258
Name:BULFORD, MARY THERESE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:BULFORD
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8352
Mailing Address - Fax:330-543-3891
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8352
Practice Address - Fax:330-543-3891
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17223-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner