Provider Demographics
NPI:1841057668
Name:DOCKTER, MAREN JOY
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:JOY
Last Name:DOCKTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAREN
Other - Middle Name:JOY
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 INTERCHANGE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2084
Mailing Address - Country:US
Mailing Address - Phone:701-425-8845
Mailing Address - Fax:701-498-3996
Practice Address - Street 1:1500 INTERCHANGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2084
Practice Address - Country:US
Practice Address - Phone:701-498-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC1084363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical