Provider Demographics
NPI:1245564582
Name:COWAN, WANDA ANITA-NELSON (RN)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ANITA-NELSON
Last Name:COWAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 PRODUCT DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3807
Mailing Address - Country:US
Mailing Address - Phone:248-844-9650
Mailing Address - Fax:248-844-9651
Practice Address - Street 1:2619 PRODUCT DR
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3807
Practice Address - Country:US
Practice Address - Phone:248-844-9650
Practice Address - Fax:248-844-9651
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704178358163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse