Provider Demographics
NPI:1508894908
Name:LOCKE, JANICE DOROTHY (MS, GNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:DOROTHY
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MS, GNP-BC
Other - Prefix:
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Mailing Address - Street 1:5525 RESEARCH PARK DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4664
Mailing Address - Country:US
Mailing Address - Phone:248-668-8650
Mailing Address - Fax:248-668-8650
Practice Address - Street 1:41100 FOX RUN
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-4804
Practice Address - Country:US
Practice Address - Phone:248-668-8650
Practice Address - Fax:248-668-8651
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704136295363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
223695886OtherTRICARE NORTH
83-20307OtherEVERCARE
83-20307OtherEVERCARE