Provider Demographics
NPI:1215363650
Name:MCGOWAN, MOLLY ELIZABETH (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:M
Other - Last Name:ODUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2731 MLK JR. BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-5235
Mailing Address - Country:US
Mailing Address - Phone:205-349-3250
Mailing Address - Fax:205-752-1517
Practice Address - Street 1:2731 MLK JR. BLVD.
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5235
Practice Address - Country:US
Practice Address - Phone:205-349-3250
Practice Address - Fax:205-752-1517
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105530363LF0000X
AL1-05530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily