Provider Demographics
NPI:1477930626
Name:LOWERY, LEAH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:LOWERY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 WILLOW SPRINGS RD STE 3S
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6153
Mailing Address - Country:US
Mailing Address - Phone:708-482-1099
Mailing Address - Fax:
Practice Address - Street 1:4727 WILLOW SPRINGS RD STE 3S
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6153
Practice Address - Country:US
Practice Address - Phone:708-482-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041334421163W00000X
IL209012788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse