MEDICARE: DANA LOCKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1073041232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LOCKE

Provider Business Mailing Address
First Line	:	3150 CARLISLE BLVD NE STE 105
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 CARLISLE BLVD NE STE 105
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1680
Country	:	US
Telephone Number	:	505-663-6017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	09/11/2024

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Directions to “ DANA LOCKE ” Practice Location

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