MEDICARE: HOLLY MARIE LOWRY MA

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	246RP1900X	Phlebotomy Technician	B6H8B6K4

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124766217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY MARIE LOWRY MA

Provider Business Mailing Address
First Line	:	4639 REED RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4639 REED RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3543
Country	:	US
Telephone Number	:	260-797-6421
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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