Provider Demographics
NPI:1033871181
Name:LOCKETT, NORMA RAE (NURSE)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:RAE
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 WALTHAM WOODS RD APT B
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2553
Mailing Address - Country:US
Mailing Address - Phone:443-854-3860
Mailing Address - Fax:
Practice Address - Street 1:8939 WALTHAM WOODS RD APT B
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2553
Practice Address - Country:US
Practice Address - Phone:443-854-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
AL2069313164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2-069313OtherLPN