Individual
LILLIE DEMAREST BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4320 DIPLOMACY DR, ANCHORAGE, AK 99508-5925
(907) 729-3300
Mailing address
7033 E TUDOR RD, ANCHORAGE, AK 99507-1262
(907) 729-8961
(907) 729-6353
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
AK
Other
Enumeration date
09/16/2021
Last updated
03/09/2023
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