Provider Demographics
NPI:1124883145
Name:LOW, OLIVIA SHAWNEA (LPN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SHAWNEA
Last Name:LOW
Suffix:
Gender:F
Credentials:LPN
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 39
Mailing Address - Street 2:
Mailing Address - City:USK
Mailing Address - State:WA
Mailing Address - Zip Code:99180-0039
Mailing Address - Country:US
Mailing Address - Phone:509-445-1147
Mailing Address - Fax:509-445-1705
Practice Address - Street 1:1821 LECLERC RD N STE 1
Practice Address - Street 2:
Practice Address - City:CUSICK
Practice Address - State:WA
Practice Address - Zip Code:99119-5015
Practice Address - Country:US
Practice Address - Phone:509-447-7111
Practice Address - Fax:509-445-1152
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60588712164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse