Provider Demographics
NPI:1215528229
Name:LOCKS, CICELY P (RN)
Entity type:Individual
Prefix:MISS
First Name:CICELY
Middle Name:P
Last Name:LOCKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CICELY
Other - Middle Name:P
Other - Last Name:LOCKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5100 BUCKEYSTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8344
Mailing Address - Country:US
Mailing Address - Phone:443-851-0635
Mailing Address - Fax:
Practice Address - Street 1:1191 NW TAHOE LN
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7954
Practice Address - Country:US
Practice Address - Phone:443-692-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172541163WP0808X, 363LP0808X
WAAP61351070363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health