Provider Demographics
NPI:1699362806
Name:TELECARE MEDICINE, LLC
Entity Type:Organization
Organization Name:TELECARE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKWOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:815-954-8331
Mailing Address - Street 1:652 PHEASANT TRL
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9540
Mailing Address - Country:US
Mailing Address - Phone:815-954-8331
Mailing Address - Fax:815-469-1311
Practice Address - Street 1:652 PHEASANT TRL
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9540
Practice Address - Country:US
Practice Address - Phone:815-954-8331
Practice Address - Fax:815-469-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty