Basic Information
| Provider Information | |||||||||
| NPI: | 1861918799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULCROFT | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | ELISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11919 UDALL RD | ||||||||
| Address2: | |||||||||
| City: | HIRAM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442349779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404776008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6847 N CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | RAVENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442663929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302970811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 11/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN.375870 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.