Provider Demographics
NPI:1588090765
Name:BULMAN, RENA B (LPN)
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:B
Last Name:BULMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:4045 CIRCLE DRIVE
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-0298
Mailing Address - Country:US
Mailing Address - Phone:315-576-0530
Mailing Address - Fax:
Practice Address - Street 1:4045 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-0298
Practice Address - Country:US
Practice Address - Phone:315-576-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234384-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse