Provider Demographics
NPI:1578754982
Name:BOCK, LAUREN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:BOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:265 LAKE WOOD PL
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-9636
Mailing Address - Country:US
Mailing Address - Phone:757-651-1142
Mailing Address - Fax:
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:SUITE B101
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3715
Practice Address - Country:US
Practice Address - Phone:360-675-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60306069363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical