Provider Demographics
NPI:1962102400
Name:BULLIS-BILLINGSLEY, BRITTANY JO (CNP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JO
Last Name:BULLIS-BILLINGSLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 BLACKFOOT ST NW STE 490
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2773
Mailing Address - Country:US
Mailing Address - Phone:612-871-7278
Mailing Address - Fax:
Practice Address - Street 1:11850 BLACKFOOT ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2578
Practice Address - Country:US
Practice Address - Phone:763-427-1137
Practice Address - Fax:763-427-4643
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9992363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care