Provider Demographics
NPI:1174676571
Name:COWPERTHWAIT, MERIDITH JOHNSON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MERIDITH
Middle Name:JOHNSON
Last Name:COWPERTHWAIT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-865-3737
Mailing Address - Fax:203-624-0751
Practice Address - Street 1:1 LONG WHARF DR
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5991
Practice Address - Country:US
Practice Address - Phone:203-865-3737
Practice Address - Fax:203-624-0751
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT068533163W00000X
CT003009363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
030300OtherCTCARE ID
329926OtherPREFERRED ONE