Healthcare Provider Details

I. General information

NPI: 1013454354
Provider Name (Legal Business Name): NANCY BOCKWAY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOHN MARSHALL DR
HUNTINGTON WV
25755-0002
US

IV. Provider business mailing address

1 JOHN MARSHALL DR
HUNTINGTON WV
25755-0002
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-3640
  • Fax:
Mailing address:
  • Phone: 304-696-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number100030
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.00881
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-0067
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number102495
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: