Healthcare Provider Details

I. General information

NPI: 1093343857
Provider Name (Legal Business Name): ELISHA L LOWE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 03/29/2020
Certification Date: 03/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 CITY AVE APT M208
PHILADELPHIA PA
19131-2959
US

IV. Provider business mailing address

3900 CITY AVE APT M208
PHILADELPHIA PA
19131-2959
US

V. Phone/Fax

Practice location:
  • Phone: 610-563-5465
  • Fax:
Mailing address:
  • Phone: 610-563-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN526389L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: