Provider Demographics
NPI:1184197832
Name:BULLOCK, KATIE (CD, CBC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:CD, CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1042
Mailing Address - Country:US
Mailing Address - Phone:484-557-8643
Mailing Address - Fax:
Practice Address - Street 1:107 WOODHOLLOW DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1042
Practice Address - Country:US
Practice Address - Phone:484-557-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula