Provider Demographics
NPI:1447989124
Name:BULLOCK, SHELLCY ANN
Entity type:Individual
Prefix:MS
First Name:SHELLCY
Middle Name:ANN
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 1ST ST NW LOT 33
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:ND
Mailing Address - Zip Code:58436-7421
Mailing Address - Country:US
Mailing Address - Phone:701-535-1582
Mailing Address - Fax:
Practice Address - Street 1:324 1ST ST NW LOT 33
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:ND
Practice Address - Zip Code:58436-7421
Practice Address - Country:US
Practice Address - Phone:701-535-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker