Basic Information
Provider Information
NPI: 1467926733
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOCKMAN
FirstName: RONALD
MiddleName: LEWIS
NamePrefix: MR.
NameSuffix: JR.
Credential: BSN, RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1230 MONITOR ST
Address2:  
City: WENATCHEE
State: WA
PostalCode: 988013534
CountryCode: US
TelephoneNumber: 5093001221
FaxNumber: 5096634637
Practice Location
Address1: 1230 MONITOR ST
Address2:  
City: WENATCHEE
State: WA
PostalCode: 988013534
CountryCode: US
TelephoneNumber: 5093001221
FaxNumber: 5096634637
Other Information
ProviderEnumerationDate: 01/19/2019
LastUpdateDate: 01/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN60236333WAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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