Provider Demographics
NPI:1669096392
Name:LOWERY, LYNETTE
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:LOWERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1808
Mailing Address - Country:US
Mailing Address - Phone:937-815-6636
Mailing Address - Fax:
Practice Address - Street 1:4712 BLOOMFIELD DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1808
Practice Address - Country:US
Practice Address - Phone:937-815-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide