Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0102049966 | VA |
NPI | 1346279833 |
---|---|
Provider Name | Dr. Bonnie Jean Nock |
First Address | Virginia Beach, VA 23462-4545 |
Second Address | Virginia Beach, VA 23462-4545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 24/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006800581 | (05) | VA |
19409 | BLUE CROSS BLUE SHIELD (01) | VA |
2300068 | UNITED HEALTH CARE (01) | |
462069061 | TRICARE (01) | |
906168 | (05) | NC |
G11419 | (02) |