Provider Demographics
NPI:1356658710
Name:LAROCK, WILLIAM JOHN (FNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:LAROCK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 WAGGONER RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13144-4478
Mailing Address - Country:US
Mailing Address - Phone:315-298-6654
Mailing Address - Fax:
Practice Address - Street 1:232 WAGGONER RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:NY
Practice Address - Zip Code:13144-4478
Practice Address - Country:US
Practice Address - Phone:315-298-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily