Provider Demographics
NPI:1659971083
Name:BULLOCK, BRITTANY N (STNA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W MARKET ST APT 54
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-9295
Mailing Address - Country:US
Mailing Address - Phone:937-489-3613
Mailing Address - Fax:
Practice Address - Street 1:1400 W MARKET ST APT 54
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-9295
Practice Address - Country:US
Practice Address - Phone:937-489-3613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602270101020376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide