Healthcare Provider Details

I. General information

NPI: 1114916194
Provider Name (Legal Business Name): ERIN M LOCKE M.S., RD/LDN, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
USAF ACADEMY CO
80840
US

IV. Provider business mailing address

10TH MEDICAL GROUP 4102 PINION DRIVE
U.S. AIR FORCE ACADEMY CA
80840
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2273
  • Fax:
Mailing address:
  • Phone: 719-524-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number851744
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: