Provider Demographics
NPI:1578965141
Name:COWELS, KRISTINA R (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:R
Last Name:COWELS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:R
Other - Last Name:PERROTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:66 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 BARBARA LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-3770
Practice Address - Country:US
Practice Address - Phone:603-759-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH061623-23363L00000X
MARN2275279363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110107620AMedicaid