Provider Demographics
NPI:1174671523
Name:LOWE, NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SPRINGHILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-2303
Mailing Address - Country:US
Mailing Address - Phone:251-300-2240
Mailing Address - Fax:251-300-2249
Practice Address - Street 1:1901 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2303
Practice Address - Country:US
Practice Address - Phone:251-300-2240
Practice Address - Fax:251-300-2249
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA351363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-17953OtherBCBS
ALP96909Medicare UPIN
AL510-54107Medicare ID - Type UnspecifiedAL MEDICARE
ALP00103116Medicare PIN