Provider Demographics
NPI:1902208838
Name:LOWMAN, LACEY
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:LOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:JAMISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 N BROAD STREET EXT STE 3
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-5805
Mailing Address - Country:US
Mailing Address - Phone:724-458-0232
Mailing Address - Fax:
Practice Address - Street 1:104 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314-8604
Practice Address - Country:US
Practice Address - Phone:814-425-2981
Practice Address - Fax:814-425-3433
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3109466OtherHIGHMARK MEDICARE ADVANTAGE
PA373705KAMMedicare PIN