Provider Demographics
NPI:1487604211
Name:ROWE, LORRAINE (PA-C)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:STE. 124
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-838-7834
Mailing Address - Fax:785-331-4559
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:STE. 124
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-838-7834
Practice Address - Fax:785-331-4559
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00624363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
426789OtherBC/BS OF KS
35437011OtherBC/BS OF KC
KSP00619742OtherMEDICARE RAILROAD CARRIER
KS426789Medicare PIN