Provider Demographics
NPI:1144429176
Name:LOCKNANE, DAVID J (PAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:LOCKNANE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:ARBOR VITAE
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9765
Mailing Address - Country:US
Mailing Address - Phone:715-358-2537
Mailing Address - Fax:
Practice Address - Street 1:1815 FAWN CT
Practice Address - Street 2:
Practice Address - City:ARBOR VITAE
Practice Address - State:WI
Practice Address - Zip Code:54568-9765
Practice Address - Country:US
Practice Address - Phone:715-356-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant