Provider Demographics
NPI:1356627269
Name:BROCK, NINA CARMEN
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:CARMEN
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 1:593 BERLANDER DR.
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051
Mailing Address - Country:US
Mailing Address - Phone:859-912-8504
Mailing Address - Fax:
Practice Address - Street 1:593 BERLANDER DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051
Practice Address - Country:US
Practice Address - Phone:859-912-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health