Healthcare Provider Details

I. General information

NPI: 1760757058
Provider Name (Legal Business Name): MARY LOWE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 W LAKE DR
MOUNT AIRY NC
27030-2157
US

IV. Provider business mailing address

847 W LAKE DR
MOUNT AIRY NC
27030-2157
US

V. Phone/Fax

Practice location:
  • Phone: 336-783-6919
  • Fax:
Mailing address:
  • Phone: 336-783-6919
  • Fax: 336-783-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1143268
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: