Individual
NICOLE DAVIS MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3034
Mailing address
3245 ROGERS RD, GRAHAM, NC 27253-7716
(336) 226-6527
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
145026
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052990
—
NC
01
—
P00449817
RAILRAOD-MEDICARE
NC
Enumeration date
09/18/2007
Last updated
12/15/2009
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