Basic Information
| Provider Information | |||||||||
| NPI: | 1972543247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOWY | ||||||||
| FirstName: | JED | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 749 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056610749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028518603 | ||||||||
| FaxNumber: | 8028518313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1878 MOUNTAIN ROAD | ||||||||
| Address2: | |||||||||
| City: | STOWE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022534853 | ||||||||
| FaxNumber: | 8022532587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 02/16/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1010011353 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 053 19065 | 01 | VT | VERMONT MANAGED CARE | OTHER | ONP0514 | 05 | VT | MEDICAID | 362870 | 01 | VT | MVP | OTHER | 053 19065 | 01 | VT | BLUE CROSS BLUE SHIELD | OTHER | 6795901 | 01 | VT | FLETCHER ALLEN PREFERRED | OTHER |