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MARY G BULLOCK RN, CNP
NPI 1205932902
Nurse Practitioner - Family in Roseville, MN

Active since September 16, 2006
2845 HAMLINE AVE NORTH, ROSEVILLE, MN 55113(651) 631-6100(651) 631-6343 Get Directions Write a Review

NPPES record last updated: April 25, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary G Bullock Rn, Cnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY G BULLOCK RN, CNP (NPI 1205932902) is an individual family provider in Roseville, Minnesota, licensed in Minnesota (R119074-4) and active in the NPI registry since September 2006.

NPPES Registry Identity

NPI1205932902
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMARY G BULLOCKCredential: RN, CNP
Location Address2845 HAMLINE AVE NORTHRoseville, MN 55113
Mailing Address2845 Hamline Ave NorthRoseville, MN 55113 · (651) 631-6100 · Fax (651) 631-6343
Phone(651) 631-6100
Fax(651) 631-6343
Sole ProprietorYes
Enumeration DateSeptember 16, 2006
Last NPPES UpdateApril 25, 2012
✔ NPI 1205932902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in MN · R119074-4
2845 HAMLINE AVE NORTH, Roseville, MN 55113
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Other Identifiers 3

Medicare ID-Type Unspecified500002368MN
Medicaid6676570-0MN
Medicare UPINP70940MN

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LORI L KELLY RN, CNP
Nurse Practitioner (Gerontology)
2845 HAMLINE AVE NORTH
ROSEVILLE, MN 55113
Ramsey County (651) 631-6100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Bullock's NPI number?

The NPI number for Mary Bullock is 1205932902. It was assigned to this individual provider in the NPPES registry on September 16, 2006.

Where is Mary Bullock located?

Mary Bullock practices at 2845 Hamline Ave North, Roseville, MN 55113. The listed phone number is (651) 631-6100.

What is Mary Bullock's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Mary Bullock was last updated on April 25, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.