Healthcare Provider Details

I. General information

NPI: 1366889594
Provider Name (Legal Business Name): SHELLEY LOWRIE L. A C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11640 SW CORBY DR #5
PORTLAND OR
97225
US

IV. Provider business mailing address

11640 SW CORBY DR #5
PORTLAND OR
97225
US

V. Phone/Fax

Practice location:
  • Phone: 971-221-6811
  • Fax:
Mailing address:
  • Phone: 971-221-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNTPFDN
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number00172
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: