Provider Demographics
NPI:1326772674
Name:LOWRYANNE VICK PROF LLC
Entity Type:Organization
Organization Name:LOWRYANNE VICK PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LOWRYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, ACNP-BC
Authorized Official - Phone:702-750-4753
Mailing Address - Street 1:4440 SAPPHIRE MOON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4767
Mailing Address - Country:US
Mailing Address - Phone:702-750-4753
Mailing Address - Fax:
Practice Address - Street 1:1311 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3309
Practice Address - Country:US
Practice Address - Phone:702-750-4753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty