Provider Demographics
NPI:1689091241
Name:LOWE, MARY MICHELE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MICHELE
Last Name:LOWE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700191
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-0191
Mailing Address - Country:US
Mailing Address - Phone:513-720-2565
Mailing Address - Fax:
Practice Address - Street 1:2835 ASHCROFT DR APT 10
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-8914
Practice Address - Country:US
Practice Address - Phone:513-720-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH283828163W00000X
MDAC006364367500000X
TX1050265367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse