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General NPI Number Information
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NPI Number | 1487051512
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Entity Type | Individual
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Provider Name | STELLA J LOCKE RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 28195 HEMLOCK AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-5433
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Country | US
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Telephone | 951-533-6963
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Fax |
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Provider Business Mailing Address
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Address Line | 28195 HEMLOCK AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-5433
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Country | US
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Telephone | 951-533-6963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 361795
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 361795
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License Number State | CA
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