Provider Demographics
NPI:1689015760
Name:LOWE, JORDAN LARA (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LARA
Last Name:LOWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LARA
Other - Last Name:ANTISDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4800 FRIENDSHIP AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1722
Mailing Address - Country:US
Mailing Address - Phone:412-578-5858
Mailing Address - Fax:412-578-1529
Practice Address - Street 1:4800 FRIENDSHIP AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1722
Practice Address - Country:US
Practice Address - Phone:412-578-5858
Practice Address - Fax:412-578-1529
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA056245OtherSTATE LISC
PAMX021283OtherWRITTEN AGREEMENT
1110636OtherNCCPA CERTIFICATION