Provider Demographics
NPI:1336650969
Name:LOWE, TAMMIE DARLENE (SF)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:DARLENE
Last Name:LOWE
Suffix:
Gender:F
Credentials:SF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-4105
Mailing Address - Country:US
Mailing Address - Phone:276-698-1622
Mailing Address - Fax:276-739-7964
Practice Address - Street 1:1065 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-4105
Practice Address - Country:US
Practice Address - Phone:276-698-1622
Practice Address - Fax:276-739-7964
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0170886888171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA017088700Medicaid