Provider Demographics
NPI:1366683823
Name:LOWERY, WANDA FAY (FNP)
Entity Type:Individual
Prefix:MISS
First Name:WANDA
Middle Name:FAY
Last Name:LOWERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:LOWERY
Other - Last Name:KARAPANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:912 INLET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7812
Mailing Address - Country:US
Mailing Address - Phone:843-651-4111
Mailing Address - Fax:843-492-4666
Practice Address - Street 1:912 INLET SQUARE DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7812
Practice Address - Country:US
Practice Address - Phone:843-651-4111
Practice Address - Fax:843-492-4666
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004316363LF0000X
SC20328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4248Medicaid