MEDICARE: BRENIQUE LOWE

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	225C00000X	Rehabilitation Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1700314507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENIQUE LOWE

Provider Business Mailing Address
First Line	:	4550 W SAHARA AVE APT 2226
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3617
Country	:	US
Telephone Number	:	907-830-0924
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 W SAHARA AVE APT 2226
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3617
Country	:	US
Telephone Number	:	907-830-0924
Fax Number	:

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

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	07/21/2022

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Directions to “ BRENIQUE LOWE ” Practice Location

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