Provider Demographics
NPI:1760071716
Name:HOCKER, MICHELLE ANN (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:HOCKER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 E UPMINSTER ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7606
Mailing Address - Country:US
Mailing Address - Phone:505-426-6730
Mailing Address - Fax:
Practice Address - Street 1:5726 E UPMINSTER ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7606
Practice Address - Country:US
Practice Address - Phone:505-426-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0000000000000363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care