Provider Demographics
NPI:1104510478
Name:LOWE, JACLYN CODY
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:CODY
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 N 162ND DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4608
Mailing Address - Country:US
Mailing Address - Phone:760-403-1169
Mailing Address - Fax:
Practice Address - Street 1:11177 N 162ND DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4608
Practice Address - Country:US
Practice Address - Phone:760-403-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide