Individual
BRIAN LORIN BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(239) 896-3934
Mailing address
1827 BIRCH DR, LEWISTON, ID 83501-6060
(239) 896-3934
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
261722
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
6631838-4406
UT
367500000X
Certified Registered Nurse Anesthetist
RNA-932A
ID
Other
Enumeration date
07/02/2013
Last updated
11/15/2021
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