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Individual
MAGGIE BULLOCK
Active
Individual
MAGGIE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20367
TN
363LF0000X
Family Nurse Practitioner
F0615007
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6073121
BCBS - TIN: 626002166
TN
01
—
6075769
BCBS - TIN: 200992504
TN
05
—
7100424650
—
TN
05
—
Q022139
—
TN
Enumeration date
06/02/2015
Last updated
07/11/2023
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