Provider Demographics
NPI:1053386607
Name:BULGER, CYDNEY (ANP)
Entity type:Individual
Prefix:
First Name:CYDNEY
Middle Name:
Last Name:BULGER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:CYDNEY
Other - Middle Name:A
Other - Last Name:BULGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:STE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5127
Mailing Address - Country:US
Mailing Address - Phone:651-642-2734
Mailing Address - Fax:651-637-2931
Practice Address - Street 1:2635 UNIVERSITY AVE W
Practice Address - Street 2:STE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1270
Practice Address - Country:US
Practice Address - Phone:651-603-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0888808363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN547722100Medicaid
500001886Medicare ID - Type Unspecified
MN547722100Medicaid