Healthcare Provider Details

I. General information

NPI: 1487908208
Provider Name (Legal Business Name): ANGELA HOCKLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3452 S 164TH ST
SEATAC WA
98188-3038
US

IV. Provider business mailing address

3452 S 164TH ST
SEATAC WA
98188-3038
US

V. Phone/Fax

Practice location:
  • Phone: 206-433-2413
  • Fax:
Mailing address:
  • Phone: 206-433-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00022675
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: