Provider Demographics
NPI:1689649162
Name:BULLARD, NINA (CRNA)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:BULLARD
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:907 SUMNER ST
Mailing Address - Street 2:SUITE M 201
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3374
Mailing Address - Country:US
Mailing Address - Phone:781-344-2325
Mailing Address - Fax:781-341-8544
Practice Address - Street 1:907 SUMNER ST
Practice Address - Street 2:SUITE M 201
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072
Practice Address - Country:US
Practice Address - Phone:781-344-2325
Practice Address - Fax:781-341-8544
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA177616367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered