MEDICARE: DR. NICOLE LOWERY LANMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MDL9304	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063413201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE LOWERY LANMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 125
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-0125
Country	:	US
Telephone Number	:	972-442-2300
Fax Number	:	972-442-2180

Provider Business Practice Location Address
First Line	:	501 WOODBRIDGE PARKWAY
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098
Country	:	US
Telephone Number	:	972-442-2300
Fax Number	:	972-442-2180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/15/2009

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