Provider Demographics
NPI:1194853515
Name:COWAN, CHARLOTTE M (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:M
Last Name:COWAN
Suffix:
Gender:F
Credentials:CRNA
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 702
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0702
Mailing Address - Country:US
Mailing Address - Phone:660-785-1000
Mailing Address - Fax:660-785-1237
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:NORTHEAST REGIONAL MEDICAL CENTER
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-785-1000
Practice Address - Fax:660-785-1237
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121063367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0976845Medicaid
MO8298OtherHEALTHCARE USA (GROUP)
MO918400904Medicaid
CG4336OtherRAILROAD MEDICARE
P00130500OtherRAILROAD MEDICARE
MO80177OtherHEALTHCARE USA
IA0976845Medicaid