Basic Information
Provider Information
NPI: 1992289169
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOWERY
FirstName: ANALISE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 235019
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361235019
CountryCode: US
TelephoneNumber: 3342791450
FaxNumber: 3342791660
Practice Location
Address1: 1601 WATSON BLVD
Address2:  
City: WARNER ROBINS
State: GA
PostalCode: 310933431
CountryCode: US
TelephoneNumber: 4783290051
FaxNumber: 3343954110
Other Information
ProviderEnumerationDate: 09/24/2018
LastUpdateDate: 03/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN231486GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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