Individual
MINI K LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
305 MONTGOMERY ST, DECORAH, IA 52101-2721
(563) 382-8436
(563) 382-5140
Mailing address
1100 SKYLINE DR, DECORAH, IA 52101-2514
(563) 382-4016
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000756
IA
Other
Enumeration date
01/04/2007
Last updated
07/08/2007
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