MEDICARE: STEPHANIE DIANE LOWE RN, MSN

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	364S00000X	Clinical Nurse Specialist	156916-030	WI

General Provider Information

NPI Number	:	1619113040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DIANE LOWE RN, MSN

Provider Business Mailing Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 2150
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:	414-203-8310
Fax Number	:	414-203-8311

Provider Business Practice Location Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 2150
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:	414-203-8310
Fax Number	:	414-203-8311

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

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	09/02/2011

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