Basic Information
Provider Information
NPI: 1215213707
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOCKNER
FirstName: SARA
MiddleName: KATHERINE
NamePrefix: MS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2518 MARYLAND PIKE
Address2:  
City: DES MOINES
State: IA
PostalCode: 50310
CountryCode: US
TelephoneNumber: 5152494098
FaxNumber:  
Practice Location
Address1: 700 E UNIVERSITY AVE
Address2: IOWA HEALTH SYSTEMS--IA LUTHERAN
City: DES MOINES
State: IA
PostalCode: 503162302
CountryCode: US
TelephoneNumber: 5152635612
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/27/2011
LastUpdateDate: 12/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XG-110617IAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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