Provider Demographics
NPI:1154311025
Name:LOWRY, DIANE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:LOWRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MICHAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:230 S. 6TH ST.
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-2534
Mailing Address - Country:US
Mailing Address - Phone:515-382-5471
Mailing Address - Fax:515-382-5621
Practice Address - Street 1:230 S. 6TH ST.
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-2534
Practice Address - Country:US
Practice Address - Phone:515-382-5471
Practice Address - Fax:515-382-5621
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR80980Medicare UPIN
IA04715Medicare ID - Type Unspecified