Healthcare Provider Details

I. General information

NPI: 1235278482
Provider Name (Legal Business Name): BROOKE LOWRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 SE STARK ST STE 300
GRESHAM OR
97030-3388
US

IV. Provider business mailing address

25050 SE STARK ST STE 300
GRESHAM OR
97030-3388
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-8878
  • Fax: 503-667-0310
Mailing address:
  • Phone: 503-667-8878
  • Fax: 503-667-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA171703
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: