Provider Demographics
NPI:1700415684
Name:COWLIE, SWANDRA
Entity Type:Individual
Prefix:
First Name:SWANDRA
Middle Name:
Last Name:COWLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 GLENBROOK ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-4251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4111 GLENBROOK ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-4251
Practice Address - Country:US
Practice Address - Phone:901-692-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based