Provider Demographics
NPI:1285422634
Name:LOWERY, MICHELLE (RD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:LOWERY
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 ENSIGN AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3402
Mailing Address - Country:US
Mailing Address - Phone:815-209-5591
Mailing Address - Fax:
Practice Address - Street 1:4452 ENSIGN AVE APT 104
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-3402
Practice Address - Country:US
Practice Address - Phone:815-209-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86072020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered