Provider Demographics
NPI:1780422204
Name:LOCK, MICHELE L (BSN,CEN,TCRN, VA-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:L
Last Name:LOCK
Suffix:
Gender:F
Credentials:BSN,CEN,TCRN, VA-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 QUALTROUGH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1328
Mailing Address - Country:US
Mailing Address - Phone:585-261-8664
Mailing Address - Fax:
Practice Address - Street 1:1729 QUALTROUGH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1328
Practice Address - Country:US
Practice Address - Phone:585-261-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY640336163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty