Provider Demographics
NPI:1710721907
Name:LOWE, PRISCILLA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:MARIE
Last Name:LOWE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 S HYDE PARK BLVD APT 19H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4267
Mailing Address - Country:US
Mailing Address - Phone:773-412-8598
Mailing Address - Fax:
Practice Address - Street 1:6700 W 95TH ST STE 308
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2388
Practice Address - Country:US
Practice Address - Phone:177-341-2859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041311158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily