Provider Demographics
NPI:1205286978
Name:LOWE, NOLA G
Entity type:Individual
Prefix:
First Name:NOLA
Middle Name:G
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOLA
Other - Middle Name:G
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688-0513
Mailing Address - Country:US
Mailing Address - Phone:907-373-1000
Mailing Address - Fax:888-588-5194
Practice Address - Street 1:500 E SWANSON AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7197
Practice Address - Country:US
Practice Address - Phone:907-373-1000
Practice Address - Fax:888-588-5194
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator