Provider Demographics
NPI:1932647773
Name:LOCKLIN, CARA ANNE (APN)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ANNE
Last Name:LOCKLIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 W HOLLYWOOD AVE
Mailing Address - Street 2:APT 1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4013
Mailing Address - Country:US
Mailing Address - Phone:734-395-8344
Mailing Address - Fax:
Practice Address - Street 1:2200 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3412
Practice Address - Country:US
Practice Address - Phone:773-751-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.414087163W00000X
IL209.015506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse