Healthcare Provider Details

I. General information

NPI: 1265671614
Provider Name (Legal Business Name): GRACE MARGARET LOCKWOOD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WINCHESTER RD
MEMPHIS TN
38118-6045
US

IV. Provider business mailing address

3810 WINCHESTER RD
MEMPHIS TN
38118-6045
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-1420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR856467
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR85647
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR856467
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: