Provider Demographics
NPI:1982466926
Name:LOWE, ALEXIS RAVEN (CHW0000000316)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RAVEN
Last Name:LOWE
Suffix:
Gender:F
Credentials:CHW0000000316
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 E MCKINLEY ST # A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3543
Mailing Address - Country:US
Mailing Address - Phone:602-491-3499
Mailing Address - Fax:
Practice Address - Street 1:1402 E MCKINLEY ST # A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3543
Practice Address - Country:US
Practice Address - Phone:602-491-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
AZCHW0000000316172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator