Provider Demographics
NPI:1649745084
Name:BULLOCK, LORI ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4256
Mailing Address - Country:US
Mailing Address - Phone:607-757-2154
Mailing Address - Fax:607-757-2864
Practice Address - Street 1:816 MARTIN STREET
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-757-2154
Practice Address - Fax:607-757-2864
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349742163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool