Healthcare Provider Details

I. General information

NPI: 1801020516
Provider Name (Legal Business Name): ANGELIQUE S COOK LOWRY DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CAMINO DE LAS BRISAS
CORRALES NM
87048-6919
US

IV. Provider business mailing address

PO BOX 3863
ALBUQUERQUE NM
87190-3863
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-9965
  • Fax: 505-898-1438
Mailing address:
  • Phone: 505-280-8865
  • Fax: 505-898-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number116RX
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: