Provider Demographics
NPI:1770145625
Name:HOCK, WENDY E (LPN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:HOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DARUMA PKWY
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-7909
Mailing Address - Country:US
Mailing Address - Phone:937-262-3500
Mailing Address - Fax:937-496-5274
Practice Address - Street 1:200 DARUMA PKWY
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-7909
Practice Address - Country:US
Practice Address - Phone:937-262-3500
Practice Address - Fax:937-496-5274
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.170641.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse