Provider Demographics
NPI:1972543247
Name:LOWY, JED W (APRN)
Entity type:Individual
Prefix:
First Name:JED
Middle Name:W
Last Name:LOWY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0749
Mailing Address - Country:US
Mailing Address - Phone:802-851-8603
Mailing Address - Fax:802-851-8313
Practice Address - Street 1:1878 MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672
Practice Address - Country:US
Practice Address - Phone:802-253-4853
Practice Address - Fax:802-253-2587
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT1010011353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT053 19065OtherVERMONT MANAGED CARE
VTONP0514Medicaid
VT362870OtherMVP
VT053 19065OtherBLUE CROSS BLUE SHIELD
VT6795901OtherFLETCHER ALLEN PREFERRED
VT053 19065OtherVERMONT MANAGED CARE
VTONP0514Medicaid