Provider Demographics
NPI:1053950493
Name:LOZANO, MARY ANN (LPN)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:LOZANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 CONTINENTAL PL STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4104
Mailing Address - Country:US
Mailing Address - Phone:360-610-1474
Mailing Address - Fax:
Practice Address - Street 1:2105 CONTINENTAL PL STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4104
Practice Address - Country:US
Practice Address - Phone:360-399-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60691977164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse