Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 7863 | WI |
NPI | 1003331125 |
---|---|
Provider Name | Nicole L Lowe |
First Address | Green Bay, WI 54303-4706 |
Second Address | Green Bay, WI 54303-4706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2017 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32497100 | (05) | WI |