Provider Demographics
NPI:1417439787
Name:BOCKENSTEDT, HAYLE VICTORIA
Entity Type:Individual
Prefix:
First Name:HAYLE
Middle Name:VICTORIA
Last Name:BOCKENSTEDT
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 1:17567 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52076-8100
Mailing Address - Country:US
Mailing Address - Phone:563-920-8784
Mailing Address - Fax:
Practice Address - Street 1:1111 3RD ST SW
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1725
Practice Address - Country:US
Practice Address - Phone:563-875-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA134146363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care