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NPI Code Detail

MEDICARE: MS. DENISE ANN BOCKWOLDT PHD, APRN, FNP

MEDICARE: MS. DENISE ANN BOCKWOLDT PHD, APRN, FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209001718IL
2363LF0000XFamily Nurse Practitioner209-001718IL
3363LP2300XPrimary Care Nurse Practitioner277000114IL
4363LF0000XFamily Nurse Practitioner277.000114IL

General Provider Information

NPI Number : 1376505479
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DENISE ANN BOCKWOLDT PHD, APRN, FNP
Provider Business Mailing Address
First Line : PO BOX 746721
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6721
Country : US
Telephone Number : 312-733-9730
Fax Number : 773-866-8014
Provider Business Practice Location Address
First Line : 2025 S CHICAGO ST STE B
Second Line :
City : JOLIET
State : IL
Zip : 60436-3172
Country : US
Telephone Number : 815-957-4174
Fax Number : 815-714-6202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 08/02/2023

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