Healthcare Provider Details

I. General information

NPI: 1194779603
Provider Name (Legal Business Name): LANA M LOKEN ED D, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W UNIVERSITY AVE
MITCHELL SD
57301-4358
US

IV. Provider business mailing address

2019 W 8TH AVE
MITCHELL SD
57301-1626
US

V. Phone/Fax

Practice location:
  • Phone: 605-995-2851
  • Fax:
Mailing address:
  • Phone: 605-999-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0108
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: