Provider Demographics
NPI:1023489739
Name:NICSEVIC, LOWRY
Entity type:Individual
Prefix:
First Name:LOWRY
Middle Name:
Last Name:NICSEVIC
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 1:445 WATERVLIET SHAKER ROAD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4697
Mailing Address - Country:US
Mailing Address - Phone:518-785-5511
Mailing Address - Fax:518-785-2767
Practice Address - Street 1:445 WATERVLIET SHAKER ROAD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4697
Practice Address - Country:US
Practice Address - Phone:518-785-5511
Practice Address - Fax:518-785-2767
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330640163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool