Provider Demographics
NPI:1154137693
Name:LOCKLEAR, LAURIE ANN
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8666
Mailing Address - Country:US
Mailing Address - Phone:910-217-0535
Mailing Address - Fax:
Practice Address - Street 1:1442 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8666
Practice Address - Country:US
Practice Address - Phone:910-217-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program