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Individual

MR. NICHOLAS FREEMAN BULLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
Mailing address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1308A
ID
363LX0106X
Occupational Health Nurse Practitioner
NP-1308A
ID

Other

Enumeration date
08/15/2013
Last updated
08/15/2013
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