Individual
ANDREA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
4441 E KINGS CANYON RD, FRESNO, CA 93702-3604
(559) 600-9180
Mailing address
6051 N FRESNO ST STE 102, FRESNO, CA 93710-5280
(559) 224-9078
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN687571
CA
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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