Bulli Boki, REGISTERED NURSE

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

2460149 Issued in MN

Practice address

10877 Tyler CT NE
Blaine, MN 55434-3376

Phone

(651) 497-1811

NPI assigned

Dec 16, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1033878004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10877 TYLER CT NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343376",
            "telephone_number": "651-497-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10877 TYLER CT NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343376",
            "telephone_number": "651-497-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOKI",
        "first_name": "BULLI",
        "name_prefix": "Mr.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "MN",
            "license": "2460149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Registered Nurse in Blaine, MN
• Providers in Blaine, MN by specialty
• General Practice Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.