MEDICARE: KATHLEEN LOWRY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	4704110032	MI

General Provider Information

NPI Number	:	1114046018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN LOWRY CRNA

Provider Business Mailing Address
First Line	:	28500 ORCHARD LAKE RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2936
Country	:	US
Telephone Number	:	248-851-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2624
Country	:	US
Telephone Number	:	313-966-3300
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	12/18/2025

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