Provider Demographics
NPI:1801020516
Name:COOK LOWRY, ANGELIQUE S (DOM)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:S
Last Name:COOK LOWRY
Suffix:
Gender:F
Credentials:DOM
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 3863
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-3863
Mailing Address - Country:US
Mailing Address - Phone:505-280-8865
Mailing Address - Fax:505-898-1438
Practice Address - Street 1:7 CAMINO DE LAS BRISAS
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-6919
Practice Address - Country:US
Practice Address - Phone:505-280-9965
Practice Address - Fax:505-898-1438
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM116RX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13720OtherPRESBYTERIAN
NMNM01R481OtherBLUE CROSS BLUE SHIELD