Provider Demographics
NPI:1982820247
Name:LOWE, MARY E (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:LOWE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CLARK A RD
Mailing Address - Street 2:
Mailing Address - City:WOODBOURNE
Mailing Address - State:NY
Mailing Address - Zip Code:12788-5403
Mailing Address - Country:US
Mailing Address - Phone:845-434-2109
Mailing Address - Fax:
Practice Address - Street 1:29 WENDY DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6017
Practice Address - Country:US
Practice Address - Phone:845-298-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY491317-1374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBP99569HMedicaid