NPI | 1386051068 |
---|---|
Former Name | SARA BETH BULLOCK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008771) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3008771) |
Enumeration Date | 2014-07-15 |
Last Update Date | 2023-02-15 |