Healthcare Provider Details

I. General information

NPI: 1295400273
Provider Name (Legal Business Name): CHARLENE LOWRE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLENE SIMMS

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ALBANY ST
BOSTON MA
02118-2755
US

IV. Provider business mailing address

128 W HIGH ST # 2
AVON MA
02322-1266
US

V. Phone/Fax

Practice location:
  • Phone: 857-654-1000
  • Fax: 857-654-1100
Mailing address:
  • Phone: 617-750-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberLN90877
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: