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General NPI Number Information
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NPI Number | 1205388915
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Entity Type | Individual
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Provider Name | ARIEL JANE BULLOCK APRN
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Gender | Female
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 100 SOUTH ST STE 102
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-4051
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Country | US
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Telephone | 508-765-7860
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Fax | 508-765-7861
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Provider Business Mailing Address
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Address Line | 61 SHAMROCK DR
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City | WARREN
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State | MA
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Zip | 01083-0453
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Country | US
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Telephone | 413-436-7226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2298765
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License Number State | MA
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