Provider Demographics
NPI:1104851401
Name:DOCK, PATRICIA ANTOINETTE (BS, MS, MS)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANTOINETTE
Last Name:DOCK
Suffix:
Gender:F
Credentials:BS, MS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 WEST EMERALD STREET
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-367-7740
Mailing Address - Fax:208-367-3390
Practice Address - Street 1:6200 WEST EMERALD STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-367-7740
Practice Address - Fax:208-367-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2005070170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS