Provider Demographics
NPI:1902673643
Name:LOWERY, IESHA DEANNA
Entity Type:Individual
Prefix:MISS
First Name:IESHA
Middle Name:DEANNA
Last Name:LOWERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 WILLIAMSPORT PIKE # 236
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5707
Mailing Address - Country:US
Mailing Address - Phone:304-901-6517
Mailing Address - Fax:
Practice Address - Street 1:401 HIGHLAND AVE APT 112
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4692
Practice Address - Country:US
Practice Address - Phone:304-901-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant