Provider Demographics
NPI:1497587059
Name:ROCKETT, ACACIA MARIE (RN)
Entity type:Individual
Prefix:
First Name:ACACIA
Middle Name:MARIE
Last Name:ROCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 GUILD RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-9510
Mailing Address - Country:US
Mailing Address - Phone:360-773-8926
Mailing Address - Fax:
Practice Address - Street 1:1494 DIKE ACCESS RD
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674
Practice Address - Country:US
Practice Address - Phone:360-624-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60290023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse