Provider Demographics
NPI:1023309614
Name:LOCKE, MICHELLE (DNP, AGNP-C, RNFA)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:DNP, AGNP-C, RNFA
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LEE BRANTON
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, AGNP-C, RNFA
Mailing Address - Street 1:2940 E. BANNER GATEWAY DRIVE
Mailing Address - Street 2:SUITE #450
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2165
Mailing Address - Country:US
Mailing Address - Phone:480-256-6444
Mailing Address - Fax:480-256-4734
Practice Address - Street 1:2646 E. BANNER GATEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2165
Practice Address - Country:US
Practice Address - Phone:480-256-6444
Practice Address - Fax:480-256-4734
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN140533163WR0006X
AZAP5739363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant