Provider Demographics
NPI:1275261554
Name:LOCKETT, DENISE RACHELLE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RACHELLE
Last Name:LOCKETT
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 1:505 E INGRAM ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2506
Mailing Address - Country:US
Mailing Address - Phone:520-252-6613
Mailing Address - Fax:480-228-8232
Practice Address - Street 1:505 E INGRAM ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2506
Practice Address - Country:US
Practice Address - Phone:520-252-6613
Practice Address - Fax:480-228-8232
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health