Provider Demographics
NPI:1114020013
Name:ROCK, ELSIE M (CRNA)
Entity type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:M
Last Name:ROCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0390
Mailing Address - Country:US
Mailing Address - Phone:570-346-7797
Mailing Address - Fax:
Practice Address - Street 1:100 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2116
Practice Address - Country:US
Practice Address - Phone:570-281-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN174261L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014405Medicare PIN
PA014405F4NMedicare PIN