Provider Demographics
NPI:1831670645
Name:LOWRY, ANDREA RUTH (LPN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RUTH
Last Name:LOWRY
Suffix:
Gender:F
Credentials:LPN
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 327
Mailing Address - Street 2:
Mailing Address - City:BLUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97413-0327
Mailing Address - Country:US
Mailing Address - Phone:503-508-6689
Mailing Address - Fax:
Practice Address - Street 1:52896 MCKENZIE HWY
Practice Address - Street 2:
Practice Address - City:BLUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97413-9701
Practice Address - Country:US
Practice Address - Phone:503-508-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200930100LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse