Provider Demographics
NPI:1477750875
Name:LOCKE, LOWELL TODD (LVN)
Entity Type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:TODD
Last Name:LOCKE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 JACKSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-9851
Mailing Address - Country:US
Mailing Address - Phone:661-800-6825
Mailing Address - Fax:
Practice Address - Street 1:13111 JACKSON LAKE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-9851
Practice Address - Country:US
Practice Address - Phone:661-800-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN171265164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS016220OtherINDIVIDUAL NURSE PROVIDER
CARVN004370OtherINDIVIDUAL NURSE PROVIDER