Provider Demographics
NPI:1669847844
Name:BOCKOVER, JUSTICE (FNP)
Entity Type:Individual
Prefix:MR
First Name:JUSTICE
Middle Name:
Last Name:BOCKOVER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:JUSTICE
Other - Middle Name:
Other - Last Name:BOCKOVER-DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN,FNP-CRN
Mailing Address - Street 1:601 JOHN ST # 42
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-020
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8282
Practice Address - Fax:269-341-8258
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704250432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily