NPI 1083321301

Affie Ann Bullock

Practitioner Private Vehicle Elkhart, IN

Practice location

Address: 26797 Roseland Rd, Elkhart, IN 46514-6122
Phone: (574) 215-6628

Registered specialties

Private Vehicle Primary

Transportation Services Taxonomy 347C00000X Licence 597RBZ (IN)

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Registry record

NPI: 1083321301
Entity type: Individual
Sex (as registered): Female
NPI issued: 7 Nov 2022
Record last updated: 7 Nov 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.