Provider Demographics
NPI:1568594653
Name:JOSEPHS-COWAN, CAROL ANN (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:JOSEPHS-COWAN
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 1:4746 BARRANCA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4728
Mailing Address - Country:US
Mailing Address - Phone:949-653-2959
Mailing Address - Fax:949-653-5589
Practice Address - Street 1:4746 BARRANCA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4728
Practice Address - Country:US
Practice Address - Phone:949-653-2959
Practice Address - Fax:949-653-5589
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367702363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGOtherMEDI-CAL
CAPENDINGMedicare ID - Type Unspecified
CAPENDINGOtherMEDI-CAL