Provider Demographics
NPI:1376505479
Name:BOCKWOLDT, DENISE ANN (PHD, APRN, FNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ANN
Last Name:BOCKWOLDT
Suffix:
Gender:F
Credentials:PHD, APRN, FNP
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 746721
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6721
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:2025 S CHICAGO ST STE B
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-3172
Practice Address - Country:US
Practice Address - Phone:815-957-4174
Practice Address - Fax:815-714-6202
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001718363LF0000X
IL209-001718363LF0000X
IL277000114363LP2300X
IL277.000114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care