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General NPI Number Information
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NPI Number | 1740314970
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Entity Type | Individual
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Provider Name | DANEEN LOCKE
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 29355 NORTHWESTERN HWY #200
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 248-353-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 29355 NORTHWESTERN HWY # 302
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1053
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Country | US
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Telephone | 248-228-2990
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | DL003145
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License Number State | MI
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