Healthcare Provider Details

I. General information

NPI: 1356821532
Provider Name (Legal Business Name): MARK ANTHONY PLOWMAN LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 COPPERFIELD LOOP
LUFKIN TX
75904
US

IV. Provider business mailing address

379 COPPERFIELD LOOP
LUFKIN TX
75904-3285
US

V. Phone/Fax

Practice location:
  • Phone: 936-414-2414
  • Fax:
Mailing address:
  • Phone: 936-414-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number306961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: