Provider Demographics
NPI:1881468254
Name:BULLOCK, JERI (COSMETOLOGIST)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:COSMETOLOGIST
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Mailing Address - Street 1:10000 CALDWELL DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8128
Mailing Address - Country:US
Mailing Address - Phone:310-500-8866
Mailing Address - Fax:
Practice Address - Street 1:15800 NORTHCROSS DR STE 103
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5070
Practice Address - Country:US
Practice Address - Phone:310-500-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist