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General NPI Number Information
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NPI Number | 1982320370
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Entity Type | Individual
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Provider Name | JEROME LOWE NUTRITION PRACTITION
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Gender | Male
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD STE 603C
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4851
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Country | US
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Telephone | 248-943-9641
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Fax |
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Provider Business Mailing Address
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Address Line | 16000 W 9 MILE RD STE 623
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-943-9641
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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