Provider Demographics
NPI:1124878426
Name:LOWTHER, SHANE MICHAEL
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:MICHAEL
Last Name:LOWTHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3376 DICK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1038
Mailing Address - Country:US
Mailing Address - Phone:234-303-4368
Mailing Address - Fax:
Practice Address - Street 1:3376 DICK ST APT 2
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1038
Practice Address - Country:US
Practice Address - Phone:234-303-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide