Healthcare Provider Details

I. General information

NPI: 1790384956
Provider Name (Legal Business Name): SARAH A LOCKWOOD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 11/08/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 W ONONDAGA ST
SYRACUSE NY
13202-3210
US

IV. Provider business mailing address

428 W ONONDAGA ST
SYRACUSE NY
13202-1899
US

V. Phone/Fax

Practice location:
  • Phone: 315-435-3295
  • Fax:
Mailing address:
  • Phone: 315-435-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: