Provider Demographics
NPI:1609661297
Name:BULLARD, LAWRENCE A (CARE GIVER)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:BULLARD
Suffix:
Gender:
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 PURCELL AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-2295
Mailing Address - Country:US
Mailing Address - Phone:513-480-2734
Mailing Address - Fax:
Practice Address - Street 1:448 PURCELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-2295
Practice Address - Country:US
Practice Address - Phone:513-480-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSM131379372500000X
OH372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider