MARY G BULLOCK (NPI# 1205932902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205932902 |
| Entity Type | Individual |
| Full Name | MARY G BULLOCK |
| Credential | RN, CNP |
| Practice Address |
2845 Hamline Ave North Roseville MN 55113 |
| Practice Telephone | 6516316100 |
| Practice Fax Number | 6516316343 |
| Mailing Telephone | 6516316100 |
| Mailing Fax Number | 6516316343 |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2012-04-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R119074-4 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 6676570-0 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902458037 | Mary Alisa Bullock | Counselor | 806 Bell Fork Rd, Jacksonville, NC 28540-6312 | 2019-07-09 |
| 1437553989 | Mary Bullock | Case Manager/Care Coordinator | 7437 Cobblestone East Dr, Indianapolis, IN 46236-9108 | 2014-10-13 |
| 1831224716 | Mary D. Bullock | Occupational Therapist | 8700 Stony Point Pkwy, Suite 100, Richmond, VA 23235-1962 | 2007-02-22 |
| Street Address |
2845 HAMLINE AVE NORTH |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235167503 | Lori L Kelly | Nurse Practitioner | 2845 Hamline Ave North, Roseville, MN 55113 | 2006-06-28 |
| 1679508006 | John W Mielke | Internal Medicine | 2845 Hamline Ave North, Roseville, MN 55113 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659996478 | Mary Ann Thomas | Nurse Practitioner | 1856 Hillmont Way, Roseville, CA 95661-5818 | 2020-06-08 |
| 1205465564 | Sonja Brockman | Nurse Practitioner | 2685 Long Lake Rd Ste 105, Roseville, MN 55113-1117 | 2020-04-07 |
| 1972162931 | Georgette Marie Aneed | Nurse Practitioner | 18303 E 10 Mile Rd Ste 100, Roseville, MI 48066-4989 | 2019-06-12 |
| 1710460282 | Gerlinda Marie Gordon | Nurse Practitioner | 28811 Felician St, Roseville, MI 48066-7442 | 2018-09-11 |
| 1740787837 | Sylvia A Atieno | Nurse Practitioner | Suttter Roseville Medical Center, 1 Medical Plaza, Roseville, CA 95661 | 2018-04-06 |
| 1205342391 | Stephanie Ridgley | Nurse Practitioner | 108 Mcmindes Ct, Roseville, CA 95747-5853 | 2017-12-27 |
| 1285148528 | Hyacinth Joy Lumapas Cassion | Nurse Practitioner | 701 Pleasant Grove Blvd Ste 125, Roseville, CA 95678-6194 | 2017-11-23 |
| 1326565789 | Renee Suzette Hoelzeman | Nurse Practitioner | 18472 Meier St, Roseville, MI 48066 | 2017-08-27 |
| 1265960272 | Giovannina Dillon | Nurse Practitioner | 151 N Sunrise Ave Ste 1201, Roseville, CA 95661-2961 | 2017-06-02 |
| 1467802934 | Bethany Berryhill | Nurse Practitioner | 1410 Lorimer Way, Roseville, CA 95747-6036 | 2016-06-15 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.