Individual
MARLISA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
269 GILLMAN RD STE 100, DENVER, NC 28037-7923
(704) 316-4930
(704) 316-4931
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5011333
NC
363LA2200X
Adult Health Nurse Practitioner
4704222885
MI
Other
Enumeration date
09/23/2013
Last updated
10/26/2020
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