Basic Information
| Provider Information | |||||||||
| NPI: | 1518575406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWELL | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | MAHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2921 LEARLY LN | ||||||||
| Address2: | |||||||||
| City: | ALTUS | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735211270 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 N LEE AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052727000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2020 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 109272 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.