| NPI | 1134555139 |
|---|---|
| Professional Name | MARLISA BULLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5011333) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704222885) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2020-10-26 |