Provider Demographics
NPI:1619508199
Name:LOWERY, BREN DESMOND (QMHP)
Entity Type:Individual
Prefix:
First Name:BREN
Middle Name:DESMOND
Last Name:LOWERY
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12621 YARDARM PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2123
Mailing Address - Country:US
Mailing Address - Phone:571-357-0178
Mailing Address - Fax:
Practice Address - Street 1:12621 YARDARM PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2123
Practice Address - Country:US
Practice Address - Phone:571-357-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)