Provider Demographics
NPI:1487051512
Name:LOCKE, STELLA J (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:J
Last Name:LOCKE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28195 HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5433
Mailing Address - Country:US
Mailing Address - Phone:951-533-6963
Mailing Address - Fax:
Practice Address - Street 1:28195 HEMLOCK AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5433
Practice Address - Country:US
Practice Address - Phone:951-533-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361795163WL0100X, 163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant