Individual
MARY ALICE BULLARD LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
530 YEW CT, ALTAMONTE SPRINGS, FL 32714-1459
(407) 862-7632
(407) 862-8739
Mailing address
PO BOX 160718, ALTAMONTE SPRINGS, FL 32716-0718
(407) 862-7632
(407) 862-8739
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
688942596
FL
172V00000X
Community Health Worker
Primary
688942598
FL
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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