Provider Demographics
NPI:1508825290
Name:VANLOWE, KRYSTAL (MD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:VANLOWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1319
Practice Address - Country:US
Practice Address - Phone:702-577-1622
Practice Address - Fax:702-912-4994
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074586207V00000X
CO0000351207V00000X
NV15864207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012300OtherBCBSM GROUP NUMBER
NV1508825290Medicaid
MI700H201530OtherBCBSM GROUP NUMBER
MI4991844Medicaid
NVV113762Medicare UPIN
MI0N21100Medicare PIN
MI4991844Medicaid
NV1508825290Medicaid