Provider Demographics
NPI:1255040382
Name:BULL, ASTRID OCTAVIA (MA-C, PEER COUNSELOR)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:OCTAVIA
Last Name:BULL
Suffix:
Gender:F
Credentials:MA-C, PEER COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S LOMBARD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5140
Mailing Address - Country:US
Mailing Address - Phone:509-885-0608
Mailing Address - Fax:
Practice Address - Street 1:145 S WORTHEN ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3081
Practice Address - Country:US
Practice Address - Phone:509-662-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACM61121062OtherMEDICAL ASSISTANT CERTIFICATION