Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP5739 | AZ |
NPI | 1023309614 |
---|---|
Provider Name | Dr. Michelle Locke |
First Address | Gilbert, AZ 85234-2165 |
Second Address | Gilbert, AZ 85234-2165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2011 |
Last Update Date | 19/07/2021 |