Healthcare Provider Details

I. General information

NPI: 1235381047
Provider Name (Legal Business Name): SARAH GRACE BULLARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

1801 WESTCHESTER DR
HIGH POINT NC
27262-7288
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-2840
  • Fax:
Mailing address:
  • Phone: 336-889-8446
  • Fax: 336-889-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number900265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: