Individual
TARA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 W 39TH ST, WILMINGTON, DE 19802-2117
(302) 588-6566
Mailing address
501 W 39TH ST, WILMINGTON, DE 19802-2117
(302) 588-6566
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L2-0007255
DE
Other
Enumeration date
06/10/2025
Last updated
06/10/2025
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