Provider Demographics
NPI:1982341855
Name:LOCKHART, DIANE GAIL (LPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GAIL
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 CHAD DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7428
Mailing Address - Country:US
Mailing Address - Phone:541-607-0897
Mailing Address - Fax:541-607-7474
Practice Address - Street 1:3355 CHAD DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7428
Practice Address - Country:US
Practice Address - Phone:541-607-0897
Practice Address - Fax:541-607-7474
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201130260LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse