Basic Information
| Provider Information | |||||||||
| NPI: | 1093954562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOWMAN-KEDZIERSKI | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 TOWER RD NE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300609408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704264721 | ||||||||
| FaxNumber: | 7704240391 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 TOWER RD NE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300609408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704264721 | ||||||||
| FaxNumber: | 7704240391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2009 | ||||||||
| LastUpdateDate: | 05/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN168434 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 862338670A | 05 | GA | MEDICAID |