Provider Demographics
NPI:1750905410
Name:BUKULU, ANNET NAMUJJU
Entity type:Individual
Prefix:
First Name:ANNET
Middle Name:NAMUJJU
Last Name:BUKULU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 POINT ROCK DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3862
Mailing Address - Country:US
Mailing Address - Phone:857-417-4448
Mailing Address - Fax:
Practice Address - Street 1:90 EVERETT AVE STE 12
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2317
Practice Address - Country:US
Practice Address - Phone:857-422-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273344163W00000X
MARN2303691363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse