MEDICARE: MOLLY LOWE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704287698	MI

General Provider Information

NPI Number	:	1003589276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY LOWE FNP

Provider Business Mailing Address
First Line	:	718 N SAINT JOSEPH ST UNIT K1
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-8422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 N SAINT JOSEPH ST UNIT K1
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-8422
Country	:	US
Telephone Number	:	231-386-0088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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