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General NPI Number Information
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NPI Number | 1790020063
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Entity Type | Individual
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Provider Name | RICHARD A. BULLOCK R.N.
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Gender | Male
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 7390 N SEYMOUR RD
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City | OWOSSO
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State | MI
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Zip | 48867-8611
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Country | US
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Telephone | 517-256-8522
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Fax |
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Provider Business Mailing Address
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Address Line | 7390 N SEYMOUR RD
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City | OWOSSO
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State | MI
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Zip | 48867-8611
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Country | US
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Telephone | 517-256-8522
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704288063
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License Number State | MI
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