Provider Demographics
NPI:1043303761
Name:COWEN, NANNETTE S (FNP)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:S
Last Name:COWEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 BAILEY LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NM
Mailing Address - Zip Code:13480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:358 MADISON ST.
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:NY
Practice Address - Zip Code:13480
Practice Address - Country:US
Practice Address - Phone:315-841-4937
Practice Address - Fax:315-624-5152
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF332316Medicaid
NYF332316Medicaid