1578383428 NPI number — DANIEL BULEK PMHNP

Table of content: DANIEL BULEK PMHNP (NPI 1578383428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578383428 NPI number — DANIEL BULEK PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULEK
Provider First Name:
DANIEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578383428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 SW YAMHILL ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97204-3316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-523-0296
Provider Business Mailing Address Fax Number:
503-523-0296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98660-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-828-8417
Provider Business Practice Location Address Fax Number:
971-297-1360
Provider Enumeration Date:
10/15/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  10033294 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP61612499 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10033294 . This is a "APRN-NP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: AP61612499 . This is a "ADVANCED REGISTERED NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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