Provider Demographics
NPI:1558563650
Name:COWAN, DORIS GALE (RN)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:GALE
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 1:590 NORTH 100 EAST
Mailing Address - Street 2:P. O. BOX 1572
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713
Mailing Address - Country:US
Mailing Address - Phone:806-445-9694
Mailing Address - Fax:
Practice Address - Street 1:590 NORTH 100 EAST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713
Practice Address - Country:US
Practice Address - Phone:806-445-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6337152-3102163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine