Provider Demographics
NPI:1194711341
Name:HOCKMAN, HEATHER J (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:J
Last Name:HOCKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 W FAIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4109
Mailing Address - Country:US
Mailing Address - Phone:308-381-8546
Mailing Address - Fax:308-381-8550
Practice Address - Street 1:3016 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4109
Practice Address - Country:US
Practice Address - Phone:308-381-8546
Practice Address - Fax:308-381-8550
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077225812Medicaid
NE275317Medicare ID - Type Unspecified
NE47077225812Medicaid