Provider Demographics
NPI:1346250495
Name:HOCKLEY, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HOCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 CAREW ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4788
Mailing Address - Country:US
Mailing Address - Phone:260-482-8681
Mailing Address - Fax:260-373-4699
Practice Address - Street 1:1818 CAREW ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4788
Practice Address - Country:US
Practice Address - Phone:260-482-8681
Practice Address - Fax:260-373-4699
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034622208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100338480Medicaid
INE41929Medicare UPIN
IN100338480Medicaid
IN340005087Medicare PIN
IN048010Medicare ID - Type Unspecified