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Individual

NICOLE D BULLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LBWMT

Contact information

Practice address
10303 N PORT WASHINGTON RD STE 102, MEQUON, WI 53092-5760
(262) 505-7950
Mailing address
W140N11945 COUNTRY AIRE DR, GERMANTOWN, WI 53022-2700
(262) 505-7950

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12824-146
WI

Other

Enumeration date
12/14/2020
Last updated
12/14/2020
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