Individual
MICHELLE ANGELIQUE COLLERAN BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
3010 CHISHOLM DR, HAGERMAN, ID 83332-6056
(208) 339-5980
Mailing address
3010 CHISHOLM DR, HAGERMAN, ID 83332-6056
(208) 339-5980
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N-26179
ID
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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