Provider Demographics
NPI:1215563093
Name:PROCK, DANIELLE MARIE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:PROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 WHITE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:DENAIR
Mailing Address - State:CA
Mailing Address - Zip Code:95316-9357
Mailing Address - Country:US
Mailing Address - Phone:209-606-7097
Mailing Address - Fax:
Practice Address - Street 1:911 E TUOLUMNE RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1543
Practice Address - Country:US
Practice Address - Phone:209-668-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily