Provider Demographics
NPI:1659115608
Name:LOCKWOOD, CAROLYN ELAINE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELAINE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 B JIM MEYER
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3109
Mailing Address - Country:US
Mailing Address - Phone:318-794-9121
Mailing Address - Fax:
Practice Address - Street 1:1108 JIM MEYER DR APT B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-5796
Practice Address - Country:US
Practice Address - Phone:318-794-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider