Provider Demographics
NPI:1447032198
Name:DOCKSER, STEPHANIE LAUREN (AGPCNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:DOCKSER
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LAUREN
Other - Last Name:HICKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4160
Mailing Address - Country:US
Mailing Address - Phone:973-945-6181
Mailing Address - Fax:
Practice Address - Street 1:1305 YORK AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5663
Practice Address - Country:US
Practice Address - Phone:973-945-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311388-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health