Basic Information
| Provider Information | |||||||||
| NPI: | 1205388915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULLOCK | ||||||||
| FirstName: | ARIEL | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 SHAMROCK DR | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010830453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134367226 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 SOUTH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015504051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087657860 | ||||||||
| FaxNumber: | 5087657861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN2298765 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.