Provider Demographics
NPI:1477767689
Name:ROCK, NIKKI MICHELLA (RN)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:MICHELLA
Last Name:ROCK
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 1:1061 205TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:IA
Mailing Address - Zip Code:51646-4006
Mailing Address - Country:US
Mailing Address - Phone:712-585-3778
Mailing Address - Fax:
Practice Address - Street 1:1800 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1165
Practice Address - Country:US
Practice Address - Phone:712-542-2388
Practice Address - Fax:712-542-2984
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094584163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health