Provider Demographics
NPI:1336908979
Name:LOWERY, LATISHA (NP)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:LOWERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 FLATLANDS 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3010
Mailing Address - Country:US
Mailing Address - Phone:347-645-1316
Mailing Address - Fax:
Practice Address - Street 1:10550 FLATLANDS 2ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3010
Practice Address - Country:US
Practice Address - Phone:347-645-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-121571163WL0100X
NYF421691-01363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant