Individual
MRS. QUIANA MARIA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1400 BLACKHORSE HILL RD, COATESVILLE, PA 19320-2040
(610) 384-7711
Mailing address
305 REVERE CT, COATESVILLE, PA 19320-5923
(610) 380-9929
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA003506L
PA
Other
Enumeration date
08/31/2006
Last updated
12/26/2013
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