Provider Demographics
NPI:1942379516
Name:BOCK, JANET MAE (MSN, APRN,)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:MAE
Last Name:BOCK
Suffix:
Gender:F
Credentials:MSN, APRN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13643 W SARGENT RD
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-7056
Mailing Address - Country:US
Mailing Address - Phone:402-223-3167
Mailing Address - Fax:
Practice Address - Street 1:2001 PINE LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3604
Practice Address - Country:US
Practice Address - Phone:402-261-8313
Practice Address - Fax:866-321-6448
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110019363LF0000X, 363LP0808X, 363LP0808X
NE103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025617500Medicaid
KS200587230AMedicaid
NE10025637300Medicaid
NE39240OtherBCBSNE - NEW BEGINNINGS
NENA1190001Medicare PIN
NE096938002Medicare PIN
R98983Medicare UPIN
KS200587230AMedicaid