Provider Demographics
NPI:1093883118
Name:COWLES, ANNASTACIA W (FNP)
Entity Type:Individual
Prefix:
First Name:ANNASTACIA
Middle Name:W
Last Name:COWLES
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742-0421
Mailing Address - Country:US
Mailing Address - Phone:845-794-9864
Mailing Address - Fax:845-794-9868
Practice Address - Street 1:68 HARRIS BUSHVILLE RD
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742-0421
Practice Address - Country:US
Practice Address - Phone:845-794-3300
Practice Address - Fax:845-794-9868
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330800207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1087Medicare ID - Type UnspecifiedMEDICARE PID
NYQ44454Medicare UPIN