Healthcare Provider Details

I. General information

NPI: 1972193217
Provider Name (Legal Business Name): SARAH LOCKWOOD AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 404
ANAHEIM CA
92801-2806
US

IV. Provider business mailing address

PO BOX 15090
ANAHEIM CA
92803-5090
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-8282
  • Fax: 714-772-6493
Mailing address:
  • Phone: 714-577-2124
  • Fax: 714-577-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95016084
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95016084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: