Provider Demographics
NPI:1639307432
Name:LOCKARD, MARY R (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY JEAN
Other - Middle Name:
Other - Last Name:LOCKARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:20700 VENTURA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6270
Mailing Address - Country:US
Mailing Address - Phone:818-903-7510
Mailing Address - Fax:
Practice Address - Street 1:20700 VENTURA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6270
Practice Address - Country:US
Practice Address - Phone:818-903-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily