Provider Demographics
NPI:1316266729
Name:BOCK, ELLEN (CRNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:BOCHARNIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 ARBOR WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1974
Mailing Address - Country:US
Mailing Address - Phone:610-279-7443
Mailing Address - Fax:610-279-3784
Practice Address - Street 1:721 ARBOR WAY STE 101
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1974
Practice Address - Country:US
Practice Address - Phone:610-279-7443
Practice Address - Fax:610-279-3784
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010757363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner