Individual
MRS. CHA-GA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
9858 S WESTERN AVE, EVERGREEN PARK, IL 60805-3200
(312) 705-9750
Mailing address
9858 S WESTERN AVE, EVERGREEN PARK, IL 60805-3200
(312) 705-9750
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209027433
IL
Other
Enumeration date
07/11/2023
Last updated
06/03/2025
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