Provider Demographics
NPI:1881756237
Name:BOCK, BONNIE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 TALBERT CT
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-1948
Mailing Address - Country:US
Mailing Address - Phone:410-751-5350
Mailing Address - Fax:
Practice Address - Street 1:2 COLLEGE HL
Practice Address - Street 2:WELLNESS CENTER - WINSLOW CENTER
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-4303
Practice Address - Country:US
Practice Address - Phone:410-857-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076572363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health