Individual provider Active NPI

Hanna Clair Bullard

  • Pediatric Nurse Practitioner
  • Waterford, MI
National Provider Identifier
1962213967
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
4704415427 Issued in MI
Practice address
2561 Elizabeth Lake Rd
Waterford, MI 48328-3313
Phone
(248) 682-3300
NPI assigned
Jan 17, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 4704415427 MI Primary

Addresses

Primary practice location

2561 Elizabeth Lake Rd
Waterford, MI 48328-3313

Mailing address

2561 Elizabeth Lake Rd
Waterford, MI 48328-3313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260127001054 MI Practitioner - Nurse Practitioner 2264919786 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3901 Beaubien St
Suite H
Detroit, MI 48201-2196

8524 S Western Ave
Suite 108
Oklahoma City, OK 73139-9247

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704415427MIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Pediatricians CurrentSince Jan 12, 2026 Accepting new patients
University Pediatricians CurrentSince Jan 12, 2026 Accepting new patients
Devyani Khambete, M.D.,P.C. PastSince Jan 19, 2025 Accepting new patients

Locations

36880 Woodward Ave
Ste 203
Bloomfld Hls, MI 48304
Phone (248) 269-4100

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

3901 Beaubien St
Fl 3
Detroit, MI 48201
Phone (313) 745-5906

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1737072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1962213967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2561 ELIZABETH LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2561 ELIZABETH LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283313",
            "telephone_number": "248-682-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "HANNA",
        "middle_name": "CLAIR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-17",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704415427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

Verify at the official NPI Registry.