Provider Demographics
NPI:1982369161
Name:VOLPENHEIN-BULLUCKS, LISA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:VOLPENHEIN-BULLUCKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:VOLPENHEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2002 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1210
Mailing Address - Country:US
Mailing Address - Phone:859-431-3345
Mailing Address - Fax:859-655-6374
Practice Address - Street 1:2002 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1210
Practice Address - Country:US
Practice Address - Phone:859-431-3345
Practice Address - Fax:859-655-6374
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily