Provider Demographics
NPI:1750014627
Name:LOCKE, BEVERLY M
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
Last Name:LOCKE
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 1:1642 SWEETBRIER ST SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3975
Mailing Address - Country:US
Mailing Address - Phone:330-979-5176
Mailing Address - Fax:
Practice Address - Street 1:1642 SWEETBRIER ST SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3975
Practice Address - Country:US
Practice Address - Phone:330-979-5176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider