Individual
LAURA RUTHVEN BULLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
800 W MAIN ST, LAKE CITY, SC 29560-4400
(843) 977-7337
(843) 956-5415
Mailing address
800 W MAIN ST, LAKE CITY, SC 29560-4400
(843) 977-7337
(843) 956-5415
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
19069
SC
Other
Enumeration date
09/30/2014
Last updated
09/21/2022
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