Provider Demographics
NPI:1194389916
Name:LOWDEN, MICHELLE ANN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:LOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:PUEBLO OF ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034-0328
Mailing Address - Country:US
Mailing Address - Phone:505-552-6661
Mailing Address - Fax:505-552-6426
Practice Address - Street 1:45 PINSBAARI DRIVE
Practice Address - Street 2:
Practice Address - City:PUEBLO OF ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87603
Practice Address - Country:US
Practice Address - Phone:505-552-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator