Provider Demographics
NPI:1801425210
Name:LOWTAN, REHANA LUANA
Entity type:Individual
Prefix:
First Name:REHANA
Middle Name:LUANA
Last Name:LOWTAN
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 1:3101 AVENUE I APT 6C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3855
Mailing Address - Country:US
Mailing Address - Phone:347-463-3697
Mailing Address - Fax:
Practice Address - Street 1:3101 AVENUE I APT 6C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3855
Practice Address - Country:US
Practice Address - Phone:347-463-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0677596363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care