Provider Demographics
NPI:1659035244
Name:COWAN, BAILEE (BSN)
Entity Type:Individual
Prefix:
First Name:BAILEE
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 FORT NUGENT RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-8881
Mailing Address - Country:US
Mailing Address - Phone:360-632-6586
Mailing Address - Fax:
Practice Address - Street 1:2431 JAFER CT
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5587
Practice Address - Country:US
Practice Address - Phone:208-656-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61230781163W00000X
ID67712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse