Provider Demographics
NPI:1720033004
Name:LOWREY, LAURA L (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:LOWREY
Suffix:
Gender:F
Credentials:NP
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 299
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130
Mailing Address - Country:US
Mailing Address - Phone:575-356-6652
Mailing Address - Fax:575-359-6827
Practice Address - Street 1:42121 US 70
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130
Practice Address - Country:US
Practice Address - Phone:575-356-6652
Practice Address - Fax:575-359-6827
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR35106363LF0000X
NMCNP00737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00247987OtherRR MEDICARE
NMNM006A94OtherBCBS
Q23477Medicare UPIN
345529401Medicare ID - Type Unspecified