Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AG10190086 | NC |
NPI | 1013551076 |
---|---|
Provider Name | Michelle Lowery |
First Address | Columbia, MD 21044-2655 |
Second Address | Rowland, NC 28383-8613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2019 |
Last Update Date | 03/11/2019 |