Provider Demographics
NPI:1487950994
Name:LOWERY, JENNIFER HAUSGEN (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAUSGEN
Last Name:LOWERY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-0456
Mailing Address - Country:US
Mailing Address - Phone:318-548-3972
Mailing Address - Fax:
Practice Address - Street 1:1118 S FARMERVILLE ST
Practice Address - Street 2:MEDICAL STAFF SERVICES
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5914
Practice Address - Country:US
Practice Address - Phone:318-232-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN111568-AP06374367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered