Provider Demographics
NPI:1205388915
Name:BULLOCK, ARIEL JANE (APRN)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:JANE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MA
Mailing Address - Zip Code:01083-0453
Mailing Address - Country:US
Mailing Address - Phone:413-436-7226
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH ST STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4051
Practice Address - Country:US
Practice Address - Phone:508-765-7860
Practice Address - Fax:508-765-7861
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2298765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily