Provider Demographics
NPI:1316224454
Name:COWAN GERIATRIC CARE LLC
Entity Type:Organization
Organization Name:COWAN GERIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANESHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-289-0564
Mailing Address - Street 1:PO BOX 41784
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-1784
Mailing Address - Country:US
Mailing Address - Phone:901-289-0564
Mailing Address - Fax:
Practice Address - Street 1:10377 TRAIL HILL LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-6670
Practice Address - Country:US
Practice Address - Phone:901-289-0564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN147062163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Single Specialty