Provider Demographics
NPI:1891749271
Name:LOWE, MARIE (ANP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1209
Mailing Address - Country:US
Mailing Address - Phone:585-591-0718
Mailing Address - Fax:
Practice Address - Street 1:165 BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1413
Practice Address - Country:US
Practice Address - Phone:585-786-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303253-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02170487Medicaid
NY9512365OtherINDEPENDENT HEALTH
NYP019303253OtherROCH BS
NY9512365OtherINDEPENDENT HEALTH