Provider Demographics
NPI:1063413201
Name:LANMAN, NICOLE LOWERY (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LOWERY
Last Name:LANMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0125
Mailing Address - Country:US
Mailing Address - Phone:972-442-2300
Mailing Address - Fax:972-442-2180
Practice Address - Street 1:501 WOODBRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:972-442-2300
Practice Address - Fax:972-442-2180
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDL9304208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174063101Medicaid
TX174063101Medicaid