MEDICARE: ANGELIQUE S. COOK-LOWRY, D.O.M., PA

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	171100000X	Acupuncturist	116RX2	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM01R481	OTHER	NM	BCBS
2	13720	OTHER	NM	PRESBYTERIAN

General Provider Information

NPI Number	:	1831253038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIQUE S. COOK-LOWRY, D.O.M., PA

Provider Business Mailing Address
First Line	:	PO BOX 3863
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87190-3863
Country	:	US
Telephone Number	:	505-280-9965
Fax Number	:	505-898-1438

Provider Business Practice Location Address
First Line	:	7 CAMINO DE LAS BRISAS
Second Line	:
City	:	CORRALES
State	:	NM
Zip	:	87048-6919
Country	:	US
Telephone Number	:	505-280-9965
Fax Number	:	505-898-1438

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELIQUE S. COOK-LOWRY
Credential	:	D.O.M.
Telephone Number	:	505-280-9965

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	05/08/2009

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