Provider Demographics
NPI:1891551255
Name:BOCK, MARIA (RD, LD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 NE KINGWOOD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9526
Mailing Address - Country:US
Mailing Address - Phone:319-329-8062
Mailing Address - Fax:
Practice Address - Street 1:326 NE KINGWOOD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9526
Practice Address - Country:US
Practice Address - Phone:319-329-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120427133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered