Healthcare Provider Details

I. General information

NPI: 1235536350
Provider Name (Legal Business Name): NAOMI LOCKETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SHAFER CT STE 300
ROSEMONT IL
60018-4929
US

IV. Provider business mailing address

17855 DALLAS PKWY STE 200
DALLAS TX
75287-6857
US

V. Phone/Fax

Practice location:
  • Phone: 847-759-9449
  • Fax: 847-759-9448
Mailing address:
  • Phone: 909-295-6006
  • Fax: 909-331-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012080
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209012080
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: