Healthcare Provider Details

I. General information

NPI: 1285817643
Provider Name (Legal Business Name): LYNNAE MARIE LOCKETT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 03/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 W 134TH ST
CLEVELAND OH
44111-3364
US

IV. Provider business mailing address

3695 W 134TH ST
CLEVELAND OH
44111-3364
US

V. Phone/Fax

Practice location:
  • Phone: 216-923-1359
  • Fax:
Mailing address:
  • Phone: 216-923-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN305666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: