Provider Demographics
NPI:1033802921
Name:LOCKLEAR, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 COOK RD
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:NC
Mailing Address - Zip Code:28386-9438
Mailing Address - Country:US
Mailing Address - Phone:910-733-7318
Mailing Address - Fax:
Practice Address - Street 1:402 COOK RD
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:NC
Practice Address - Zip Code:28386-9438
Practice Address - Country:US
Practice Address - Phone:910-733-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program