Provider Demographics
NPI:1730164450
Name:BOCK, LORRAINE WENTZ (CRNP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:WENTZ
Last Name:BOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DANNAH DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7924
Mailing Address - Country:US
Mailing Address - Phone:717-440-0098
Mailing Address - Fax:717-918-5784
Practice Address - Street 1:9 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3016
Practice Address - Country:US
Practice Address - Phone:717-440-0098
Practice Address - Fax:717-918-5784
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN167340363LF0000X
PATP-003409-B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATP003409BOtherSTATE LICENSE NUMBER