Provider Demographics
NPI:1396830956
Name:BULLOCK, SABRINA (LM)
Entity Type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 EGYPT MTN. RD.
Mailing Address - Street 2:
Mailing Address - City:KITTRELL
Mailing Address - State:NC
Mailing Address - Zip Code:27544-9603
Mailing Address - Country:US
Mailing Address - Phone:252-432-0102
Mailing Address - Fax:252-438-3735
Practice Address - Street 1:606 VIRGINIA AVENUE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927
Practice Address - Country:US
Practice Address - Phone:252-432-0102
Practice Address - Fax:252-438-3735
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000011176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife