MEDICARE: MS. LAURA JANE LOCKHART CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	036534	NC

General Provider Information

NPI Number	:	1104852854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA JANE LOCKHART CRNA

Provider Business Mailing Address
First Line	:	12412 DARBY CHASE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3200
Country	:	US
Telephone Number	:	704-846-9613
Fax Number	:	704-846-9613

Provider Business Practice Location Address
First Line	:	706 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2708
Country	:	US
Telephone Number	:	704-730-5405
Fax Number	:	704-730-5399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	07/08/2007

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