1023014438 NPI number — NICOLE T LOWE M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023014438 NPI number — NICOLE T LOWE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWE
Provider First Name:
NICOLE
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023014438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9855 HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-581-9220
Provider Business Mailing Address Fax Number:
763-581-9221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9855 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369-4648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-581-9220
Provider Business Practice Location Address Fax Number:
763-581-9221
Provider Enumeration Date:
06/22/2005

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: 207P00000X , with the licence number:  BL6168442 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 036101859 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 54499 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 080172806 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 441397 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036101859 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38398 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0100970 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1023014438 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4622029 . This is a "ADMINISTAR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036101859-3 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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