Individual
MICHELLE BOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2514 E DUPONT RD STE 100, FORT WAYNE, IN 46825-1619
(260) 484-8830
Mailing address
PO BOX 749495, ATLANTA, GA 30374-9495
(855) 963-2100
(239) 236-2775
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005186A
IN
363LF0000X
Family Nurse Practitioner
71005186A
IN
Other
Enumeration date
11/04/2014
Last updated
12/09/2024
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