Provider Demographics
NPI:1043749252
Name:LOWENSTEIN, SOPHIA HEEN (RN, ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:HEEN
Last Name:LOWENSTEIN
Suffix:
Gender:F
Credentials:RN, ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 SAN MATEO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1434
Mailing Address - Country:US
Mailing Address - Phone:505-485-0464
Mailing Address - Fax:505-266-1017
Practice Address - Street 1:7155 E 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1630
Practice Address - Country:US
Practice Address - Phone:303-321-2458
Practice Address - Fax:303-321-0498
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60562786163W00000X
WAAP60732206363L00000X
WACMM03992367A00000X
COAPN.0993391-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000162184Medicaid
WA201198522WAMedicaid