Provider Demographics
NPI:1346750262
Name:DEQUIROS, LOWELLA CAMILLE (NP-C)
Entity type:Individual
Prefix:
First Name:LOWELLA CAMILLE
Middle Name:
Last Name:DEQUIROS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23481 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3262
Mailing Address - Country:US
Mailing Address - Phone:734-250-1878
Mailing Address - Fax:
Practice Address - Street 1:1039 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2016
Practice Address - Country:US
Practice Address - Phone:313-563-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704258694363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care