Provider Demographics
NPI:1508024183
Name:ESTOCK, DENISE A
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:ESTOCK
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 1:332 N FREEDOM AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-1814
Mailing Address - Country:US
Mailing Address - Phone:330-821-7362
Mailing Address - Fax:
Practice Address - Street 1:332 N FREEDOM AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-1814
Practice Address - Country:US
Practice Address - Phone:330-821-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2170118Medicaid