MRS. CHA-GA BULLOCK FNP-BC NPI 1639858319

NPI Information

NPI: 1639858319
Provider Name: MRS. CHA-GA BULLOCK, FNP-BC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
4400 W 95TH ST STE 310
OAK LAWN, IL
ZIP 60453
Phone: (708) 684-9230
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MRS. Cha-ga Bullock, FNP-BC is a family nurse practitioner in Oak Lawn, IL with 2 years of experience. MRS. Cha-ga Bullock, FNP-BC NPI is 1639858319. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4400 W 95TH ST STE 310
OAK LAWN, IL
ZIP 60453-660
Phone: (708) 684-9230

The NPI 1639858319 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/11/2023 and was last updated on 12/14/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	209027433	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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