Provider Demographics
NPI:1396389904
Name:FLOCK, JOYCE ELLA
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELLA
Last Name:FLOCK
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 1:3250 230TH AVE
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:MN
Mailing Address - Zip Code:56239-1104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1341
Practice Address - Country:US
Practice Address - Phone:507-532-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN677967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse