Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 01026297A | IN |
NPI | 1003024225 |
---|---|
Provider Name | Dr. Cecile Crane Locke |
First Address | Cicero, IN 46034-9691 |
Second Address | Noblesville, IN 46062-8921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 08/07/2007 |