Provider Demographics
NPI:1104852854
Name:LOCKHART, LAURA JANE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:12412 DARBY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3200
Mailing Address - Country:US
Mailing Address - Phone:704-846-9613
Mailing Address - Fax:704-846-9613
Practice Address - Street 1:706 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2708
Practice Address - Country:US
Practice Address - Phone:704-730-5405
Practice Address - Fax:704-730-5399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC036534367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered