Provider Demographics
NPI:1578562997
Name:LOWE, TAMMY (FNP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 W HARBECK RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5769
Mailing Address - Country:US
Mailing Address - Phone:541-441-0411
Mailing Address - Fax:
Practice Address - Street 1:1619 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE201
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-6008
Practice Address - Country:US
Practice Address - Phone:541-474-1020
Practice Address - Fax:541-474-1108
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165115363L00000X
OR363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269628Medicaid
OR269628Medicaid