Provider Demographics
NPI:1477557429
Name:LOCHRIDGE, GLORIA LEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:LEE
Last Name:LOCHRIDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0939
Mailing Address - Country:US
Mailing Address - Phone:209-754-6262
Mailing Address - Fax:866-206-8079
Practice Address - Street 1:18382 TUOLUMNE RD
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9754
Practice Address - Country:US
Practice Address - Phone:209-928-4004
Practice Address - Fax:209-928-4988
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208513163W00000X
CANP12021363L00000X
CA57547364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18686ZMedicare PIN
P24644Medicare UPIN