Provider Demographics
NPI:1255526281
Name:LOWE, FELICIA STARR (LICENSE PRACTICAL NU)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:STARR
Last Name:LOWE
Suffix:
Gender:F
Credentials:LICENSE PRACTICAL NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 N TEUTONIA AVE
Mailing Address - Street 2:APT 33
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209
Mailing Address - Country:US
Mailing Address - Phone:414-719-4589
Mailing Address - Fax:
Practice Address - Street 1:9145 N SWAN RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224
Practice Address - Country:US
Practice Address - Phone:414-365-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35026800Medicaid