Provider Demographics
NPI:1538478045
Name:MEDLOCK, DANA LYN (CPM)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYN
Last Name:MEDLOCK
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2115
Mailing Address - Country:US
Mailing Address - Phone:314-288-5249
Mailing Address - Fax:
Practice Address - Street 1:1504 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-2115
Practice Address - Country:US
Practice Address - Phone:314-288-5249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife