Provider Demographics
NPI:1437243946
Name:GOWANS, JANINE ANNE (NP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:ANNE
Last Name:GOWANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E RIVER ROAD
Mailing Address - Street 2:STE 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:2222 E. HIGHLAND AVE.
Practice Address - Street 2:#400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-277-4868
Practice Address - Fax:602-230-9350
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN087605164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ174867Medicaid
AZ174867Medicaid
AZ111656Medicare PIN