Provider Demographics
NPI:1477809648
Name:LOWER, WESLEY A (CCP)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:A
Last Name:LOWER
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N MAY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6641
Mailing Address - Country:US
Mailing Address - Phone:405-604-5613
Mailing Address - Fax:405-601-3750
Practice Address - Street 1:3601 N MAY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6641
Practice Address - Country:US
Practice Address - Phone:405-604-5613
Practice Address - Fax:405-601-3750
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist