Provider Demographics
NPI:1073834271
Name:COWAN, MARY A (MSN, APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:COWAN
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:RAYNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 NE SAINT LUKES BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6001
Mailing Address - Country:US
Mailing Address - Phone:816-282-7809
Mailing Address - Fax:816-282-7870
Practice Address - Street 1:20 NE SAINT LUKES BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6001
Practice Address - Country:US
Practice Address - Phone:816-282-7809
Practice Address - Fax:816-282-7870
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO093641363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health