Nicole Bullock, LBWMT

NPI 1023604048 · on the registry since 2020 · sole proprietor

Practice

Address: 10303 N Port Washington Rd Ste 102
Mequon, WI 53092
Phone: (262) 505-7950
Organisation at this address: Northshore Smiles, Llc
Forefront Dermatology, S.C.
North Shore Dermatology, S.C.
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 13

Registry record

Primary taxonomy: 225700000X
225700000X
Licence states on file: WI
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2020-12-14

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin