Healthcare Provider Details

I. General information

NPI: 1023309614
Provider Name (Legal Business Name): MICHELLE LOCKE DNP, AGNP-C, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE LEE BRANTON LOCKE DNP, AGNP-C, RNFA

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 07/19/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 E. BANNER GATEWAY DRIVE
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2940 E. BANNER GATEWAY DRIVE SUITE #450
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-4734
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN140533
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP5739
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: