MEDICARE: MRS. VELVET DAWN LOCKLIN R.N.

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	163W00000X	Registered Nurse	22371	WY
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1356488555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VELVET DAWN LOCKLIN R.N.

Provider Business Mailing Address
First Line	:	PO BOX 18
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-0018
Country	:	US
Telephone Number	:	307-472-9224
Fax Number	:	307-472-9224

Provider Business Practice Location Address
First Line	:	11002 RIDGEVIEW RD
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-9825
Country	:	US
Telephone Number	:	307-267-4101
Fax Number	:	307-234-9329

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/09/2024

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