Provider Demographics
NPI:1205126620
Name:DOWELL, JOSEPH ANTHONY (LPN)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:DOWELL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 HIGHBRIDGE ST
Mailing Address - Street 2:APT 7-E
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2411
Mailing Address - Country:US
Mailing Address - Phone:315-450-4711
Mailing Address - Fax:
Practice Address - Street 1:5100 HIGHBRIDGE ST
Practice Address - Street 2:APT 7-E
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2411
Practice Address - Country:US
Practice Address - Phone:315-450-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse