Provider Demographics
NPI:1285817643
Name:LOCKETT, LYNNAE MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNNAE
Middle Name:MARIE
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 W 134TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3364
Mailing Address - Country:US
Mailing Address - Phone:216-923-1359
Mailing Address - Fax:
Practice Address - Street 1:3695 W 134TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3364
Practice Address - Country:US
Practice Address - Phone:216-923-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN305666163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine