Provider Demographics
NPI:1861410078
Name:LOCKWOOD, JEFFREY (RN/CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:RN/CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 ELK RUN DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3731
Mailing Address - Country:US
Mailing Address - Phone:541-924-2815
Mailing Address - Fax:541-924-2815
Practice Address - Street 1:1330 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4206
Practice Address - Country:US
Practice Address - Phone:503-763-1973
Practice Address - Fax:503-763-8886
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081046589367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262825Medicaid
OR048475OtherAANA
ORP00225831OtherRAILROAD MEDICARE
OR081046589OtherRN/CRNA
OR081046589OtherRN/CRNA
ORP00225831OtherRAILROAD MEDICARE