Provider Demographics
NPI:1437864410
Name:LOWE-DEACON, LORIS EDA
Entity Type:Individual
Prefix:
First Name:LORIS
Middle Name:EDA
Last Name:LOWE-DEACON
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 1:119A S 9TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3018
Mailing Address - Country:US
Mailing Address - Phone:914-882-6543
Mailing Address - Fax:
Practice Address - Street 1:119A S 9TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3018
Practice Address - Country:US
Practice Address - Phone:914-882-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327099-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse