Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | D5150 | ID |
Y | 1223G0001X | General Practice | D-5150 | ID |
Y | 213EG0000X | General Practice | D-5150 | ID |
NPI | 1053920934 |
---|---|
Provider Name | Dr. Tais Trevelin Lowry |
First Address | Coeur D Alene, ID 83814-2570 |
Second Address | Coeur D Alene, ID 83814-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2020 |
Last Update Date | 30/07/2020 |