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General NPI Number Information
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NPI Number | 1558172106
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Entity Type | Individual
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Provider Name | MARSHA LOCKE
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 214 E 23RD ST
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City | CHEYENNE
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State | WY
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Zip | 82001-3748
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Country | US
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Telephone | 307-634-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2 KIMBERLY TRL # 2
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City | DANBURY
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State | CT
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Zip | 06810-7209
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Country | US
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Telephone | 203-733-4916
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 55719
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License Number State | WY
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