1295280881 NPI number — MALLORY KAY LOWRANCE AU.D.

Table of content: MALLORY KAY LOWRANCE AU.D. (NPI 1295280881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295280881 NPI number — MALLORY KAY LOWRANCE AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWRANCE
Provider First Name:
MALLORY
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STUDEBAKER
Provider Other First Name:
MALLORY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295280881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9002 N MERIDIAN ST STE 222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-5350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-573-4370
Provider Business Mailing Address Fax Number:
317-819-0044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEMORIAL SQ
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46140-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-844-7059
Provider Business Practice Location Address Fax Number:
819-819-0044
Provider Enumeration Date:
08/24/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  23002606A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)