Provider Demographics
NPI:1730408022
Name:BULBOTKO, NADEZHDA (RN)
Entity type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:BULBOTKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 SUNSET CENTER LN
Mailing Address - Street 2:APT 202
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1127
Mailing Address - Country:US
Mailing Address - Phone:585-637-5795
Mailing Address - Fax:
Practice Address - Street 1:99 SUNSET CENTER LN
Practice Address - Street 2:APT 202
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1127
Practice Address - Country:US
Practice Address - Phone:585-637-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628760-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse