Provider Demographics
NPI:1528091329
Name:HOCKSTRA, MICHELLE LEBORYS (NP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEBORYS
Last Name:HOCKSTRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LEBORYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2612 TRIADELPHIA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-1414
Mailing Address - Country:US
Mailing Address - Phone:410-627-6153
Mailing Address - Fax:
Practice Address - Street 1:8197 WESTSIDE BLVD
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2590
Practice Address - Country:US
Practice Address - Phone:410-627-6153
Practice Address - Fax:301-570-0990
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S81454Medicare UPIN