Healthcare Provider Details

I. General information

NPI: 1609012012
Provider Name (Legal Business Name): SUSAN D LOWE RN,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18432 GRIDLEY RD
ARTESIA CA
90701-5404
US

IV. Provider business mailing address

20751 AQUATIC LN
HUNTINGTON BEACH CA
92646-6602
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-2479
  • Fax:
Mailing address:
  • Phone: 714-962-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number185217
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: