Provider Demographics
NPI:1235773656
Name:BROCK, KRISTINE JOY
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:JOY
Last Name:BROCK
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:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:VOLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57072-0136
Mailing Address - Country:US
Mailing Address - Phone:605-857-5066
Mailing Address - Fax:
Practice Address - Street 1:303 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:VOLIN
Practice Address - State:SD
Practice Address - Zip Code:57072-7712
Practice Address - Country:US
Practice Address - Phone:605-857-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker