Provider Demographics
NPI:1609645241
Name:BROCK, FIONDA WILLIAMS (DN, MS, MSN, RN)
Entity Type:Individual
Prefix:
First Name:FIONDA
Middle Name:WILLIAMS
Last Name:BROCK
Suffix:
Gender:F
Credentials:DN, MS, MSN, RN
Other - Prefix:
Other - First Name:FIONDA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MSN, RN
Mailing Address - Street 1:2251 HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429-8959
Mailing Address - Country:US
Mailing Address - Phone:702-427-9800
Mailing Address - Fax:
Practice Address - Street 1:1360 WILLIAM HARDY DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86429-1146
Practice Address - Country:US
Practice Address - Phone:702-427-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN160112163WC1500X, 163WH0200X, 163WM0102X, 163WP2201X, 163WW0101X, 163W00000X
171400000X, 246ZB0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No171400000XOther Service ProvidersHealth & Wellness Coach
No246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist