Healthcare Provider Details

I. General information

NPI: 1205678489
Provider Name (Legal Business Name): LADIAMOND MONAE LOWERY BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5871
US

IV. Provider business mailing address

1007 WALKER AVE
GREENSBORO NC
27403
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number337194
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: