MEDICARE: MS. AMANDA JOY LOCKE

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	163WX0003X	Inpatient Obstetric Registered Nurse	1-102079	AL

General Provider Information

NPI Number	:	1275514481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA JOY LOCKE

Provider Business Mailing Address
First Line	:	18TH MEDCOM
Second Line	:	ATTN: 1)CCS-AM (CREDENTIALS)
City	:	APO
State	:	AP
Zip	:	96205-0054
Country	:	KR
Telephone Number	:	01182279166027
Fax Number	:	01182279178110

Provider Business Practice Location Address
First Line	:	18TH MEDCOM
Second Line	:	ATTN: 1)CCS-AM (CREDENTIALS)
City	:	APO
State	:	AP
Zip	:	96205-0054
Country	:	KR
Telephone Number	:	01182279166027
Fax Number	:	01182279178110

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/21/2022

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