=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255165270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ANNE LOCKWOOD CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2024
-----------------------------------------------------
Last Update Date | 09/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10506B MONTGOMERY RD. SUITE 304
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-853-9000
-----------------------------------------------------
Fax | 513-624-2964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10506B MONTGOMERY RD. SUITE 304
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-853-9000
-----------------------------------------------------
Fax | 513-624-2964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0037487
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 2024063417
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------