Provider Demographics
NPI:1235278482
Name:LOWRY, BROOKE BJORNBERG (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:BJORNBERG
Last Name:LOWRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24900 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3355
Mailing Address - Country:US
Mailing Address - Phone:506-665-1010
Mailing Address - Fax:503-665-1023
Practice Address - Street 1:24900 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3355
Practice Address - Country:US
Practice Address - Phone:506-665-1010
Practice Address - Fax:503-665-1023
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
ORPA171703363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator