Provider Demographics
NPI:1528526241
Name:LOWDER, BRADLEY BRENT (NP-C)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:BRENT
Last Name:LOWDER
Suffix:
Gender:M
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 1:2850 OLYMPUS DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2271
Mailing Address - Country:US
Mailing Address - Phone:208-239-2237
Mailing Address - Fax:208-239-3677
Practice Address - Street 1:2850 OLYMPUS DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2271
Practice Address - Country:US
Practice Address - Phone:208-239-2273
Practice Address - Fax:208-239-3677
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID76808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily