Individual
GENNA MARIE LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2870 NE WEST DEVILS LAKE RD, LINCOLN CITY, OR 97367-5127
(541) 994-9191
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA218007
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/21/2022
Last updated
11/20/2023
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