Provider Demographics
NPI:1407092810
Name:COWAN, REGAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:ELIZABETH
Last Name:COWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 PEACEABLE ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3234
Mailing Address - Country:US
Mailing Address - Phone:518-882-6767
Mailing Address - Fax:
Practice Address - Street 1:1213 PEACEABLE ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-3234
Practice Address - Country:US
Practice Address - Phone:518-882-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4926211163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse