Provider Demographics
NPI:1447556196
Name:BOCK, SANDRA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:BOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8483 TRILLIUM DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4705
Mailing Address - Country:US
Mailing Address - Phone:440-391-2324
Mailing Address - Fax:
Practice Address - Street 1:8483 TRILLIUM DR
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4705
Practice Address - Country:US
Practice Address - Phone:440-391-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 274665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse