Provider Demographics
NPI:1356777130
Name:LOCKWOOD, LAUREN MICHELLE (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELLE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3125 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4522
Mailing Address - Country:US
Mailing Address - Phone:916-792-9308
Mailing Address - Fax:
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:SUITE 130
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-937-0995
Practice Address - Fax:925-937-3918
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22911363LW0102X
CA2014367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health