MEDICARE: SUSAN L BOCK APNP

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
1	363LP0200X	Pediatric Nurse Practitioner	2364	WI
2	363L00000X	Nurse Practitioner	2364	WI

General Provider Information

NPI Number	:	1861496689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L BOCK APNP

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54702-1510
Country	:	US
Telephone Number	:	715-838-5895
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 THEATER RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-8679
Country	:	US
Telephone Number	:	608-392-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/28/2019

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Directions to “ SUSAN L BOCK APNP” Practice Location

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