Provider Demographics
NPI:1346279833
Name:NOCK, BONNIE JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:JEAN
Last Name:NOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 SOUTH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1147
Mailing Address - Country:US
Mailing Address - Phone:757-227-3820
Mailing Address - Fax:757-226-9021
Practice Address - Street 1:4525 SOUTH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1147
Practice Address - Country:US
Practice Address - Phone:757-227-3820
Practice Address - Fax:757-226-9021
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01020499662081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006800581Medicaid
2300068OtherUNITED HEALTH CARE
VA19409OtherBLUE CROSS BLUE SHIELD
462069061OtherTRICARE
NC906168Medicaid