Healthcare Provider Details

I. General information

NPI: 1013045723
Provider Name (Legal Business Name): JEAN LOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SANTA CRUZ SE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

2925 SANTA CRUZ AVE SE
ALBUQUERQUE NM
87106-2948
US

V. Phone/Fax

Practice location:
  • Phone: 505-269-2538
  • Fax: 505-272-6845
Mailing address:
  • Phone: 505-269-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number012134
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: