Provider Demographics
NPI:1740246156
Name:LOWERY, NORMA FAYE (NP)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:FAYE
Last Name:LOWERY
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 1:18325 E 10 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4990
Mailing Address - Country:US
Mailing Address - Phone:586-773-6300
Mailing Address - Fax:586-773-6266
Practice Address - Street 1:18325 E 10 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4990
Practice Address - Country:US
Practice Address - Phone:586-773-6300
Practice Address - Fax:586-773-6266
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINL109523363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4566410Medicaid
MI1295023547OtherGROUP NPI
MI5008602470OtherBCBSM
MIQ04248Medicare UPIN
MI4566410Medicaid
MI1005840001Medicare NSC