Individual
STACIE MAREE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3485 INDEPENDENCE DR, BIRMINGHAM, AL 35209-5603
(205) 930-0920
Mailing address
3485 INDEPENDENCE DR, BIRMINGHAM, AL 35209-5603
(205) 930-0920
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-110629
AL
Other
Enumeration date
08/16/2011
Last updated
08/11/2023
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