Provider Demographics
NPI:1275599482
Name:COWELL, MATTHEW HARMER (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:HARMER
Last Name:COWELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 SHEKEL LN
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8931
Mailing Address - Country:US
Mailing Address - Phone:719-290-1186
Mailing Address - Fax:
Practice Address - Street 1:662 SHEKEL LN
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8931
Practice Address - Country:US
Practice Address - Phone:719-290-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83701163W00000X
CO42795367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35107227Medicaid