Provider Demographics
NPI:1235217688
Name:LOCKWOOD, TERESA M (CRNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-7315
Mailing Address - Fax:
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-851-7315
Practice Address - Fax:717-741-3056
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008818363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50058133OtherCAPITAL BLUECROSS
PA1015901830001Medicaid
MD953160OtherCAREFIRST MD BCBS
PA1910351OtherHIGHMARK BLUE SHIELD
PA099124KBFMedicare ID - Type Unspecified
PAP00869842Medicare PIN
PA1015901830001Medicaid
PAQ65613Medicare UPIN