Provider Demographics
NPI:1720057177
Name:BULL, KENNETH C (RN)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:C
Last Name:BULL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 GLACIER HILL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-8593
Mailing Address - Country:US
Mailing Address - Phone:608-438-6086
Mailing Address - Fax:
Practice Address - Street 1:1330 GLACIER HILL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-8593
Practice Address - Country:US
Practice Address - Phone:608-438-6086
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39941900Medicaid