Provider Demographics
NPI:1437768652
Name:BOCKIUS, EMMA FLANAGAN
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:FLANAGAN
Last Name:BOCKIUS
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 1:605 SIERRA ROSE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2093
Mailing Address - Country:US
Mailing Address - Phone:775-689-5410
Mailing Address - Fax:775-451-1713
Practice Address - Street 1:605 SIERRA ROSE DR STE 4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2093
Practice Address - Country:US
Practice Address - Phone:775-689-5410
Practice Address - Fax:775-451-1713
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2265363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant