Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 27522 | OK |
NPI | 1013206226 |
---|---|
Provider Name | Connie R Lowry |
First Address | Tulsa, OK 74136-3347 |
Second Address | Stillwater, OK 74074-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 29/03/2011 |