Provider Demographics
NPI:1831259167
Name:LOCHMULLER, KELLY (CRNA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LOCHMULLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:919 WIDEWATERS PKWY
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7323
Mailing Address - Country:US
Mailing Address - Phone:919-672-6864
Mailing Address - Fax:
Practice Address - Street 1:DUMC
Practice Address - Street 2:307 TRENT DRIVE
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:336-589-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC169821367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered