MEDICARE: CHARITY BOCK MSN, APRN, FNP-C

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	163W00000X	Registered Nurse	R65711	NM
2	363LF0000X	Family Nurse Practitioner	74145	NM

General Provider Information

NPI Number	:	1972288850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY BOCK MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1034 N SPRING ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5150
Country	:	US
Telephone Number	:	575-941-3854
Fax Number	:	575-941-3592

Provider Business Practice Location Address
First Line	:	1034 N SPRING ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5150
Country	:	US
Telephone Number	:	575-941-3854
Fax Number	:	575-941-3592

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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