1770133282 NPI number — ELIZABETH NADESCHZDA LOWELL CNP

Table of content: ELIZABETH NADESCHZDA LOWELL CNP (NPI 1770133282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770133282 NPI number — ELIZABETH NADESCHZDA LOWELL CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWELL
Provider First Name:
ELIZABETH
Provider Middle Name:
NADESCHZDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCURDY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
NADESCHZDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770133282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4881 E GRANT ROAD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-318-6035
Provider Business Mailing Address Fax Number:
520-795-9953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4881 E GRANT ROAD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-318-6035
Provider Business Practice Location Address Fax Number:
520-795-9953
Provider Enumeration Date:
09/17/2019

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: 363LF0000X , with the licence number:  228495 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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