Healthcare Provider Details

I. General information

NPI: 1760842744
Provider Name (Legal Business Name): ELIZABETH LOCKHART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 KARL RD
COLUMBUS OH
43229-5147
US

IV. Provider business mailing address

3606 HEYWOOD DR
HILLIARD OH
43026-1721
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-2588
  • Fax:
Mailing address:
  • Phone: 614-747-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN187-393
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: