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NPI Code Detail

MEDICARE: DEIDRA SHONDRECE LOWE NURSE PRACTITIONER

MEDICARE: DEIDRA SHONDRECE LOWE NURSE PRACTITIONER
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
1163W00000XRegistered NurseRN217191GA
2363LF0000XFamily Nurse Practitioner95030168CA
3363LF0000XFamily Nurse PractitionerRN217191GA

General Provider Information

NPI Number : 1386925469
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIDRA SHONDRECE LOWE NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 865 N HIGHLAND AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4565
Country : US
Telephone Number : 404-205-9499
Fax Number :
Provider Business Practice Location Address
First Line : 865 N HIGHLAND AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4565
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2011
Last Update Date : 09/26/2025

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