MEDICARE: MARY LOU LOWDEN LPN

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	164W00000X	Licensed Practical Nurse	075970	OH

General Provider Information

NPI Number	:	1376750539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LOU LOWDEN LPN

Provider Business Mailing Address
First Line	:	1938 QUAYLE DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-2142
Country	:	US
Telephone Number	:	330-784-9273
Fax Number	:	330-644-4277

Provider Business Practice Location Address
First Line	:	1938 QUAYLE DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-2142
Country	:	US
Telephone Number	:	330-784-9273
Fax Number	:	330-644-4277

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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