Provider Demographics
NPI:1366865909
Name:BULLOCK, MICHELLE (HHA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 HARAS PL
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-3053
Mailing Address - Country:US
Mailing Address - Phone:240-299-5767
Mailing Address - Fax:202-545-0934
Practice Address - Street 1:5316 HARAS PL
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-3053
Practice Address - Country:US
Practice Address - Phone:240-299-5767
Practice Address - Fax:202-545-0934
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide