Provider Demographics
NPI:1710933775
Name:COWAN, KIM ANTOINETTE (RN)
Entity Type:Individual
Prefix:MISS
First Name:KIM
Middle Name:ANTOINETTE
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 1:3211 N SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3546
Mailing Address - Country:US
Mailing Address - Phone:414-442-4408
Mailing Address - Fax:414-442-4408
Practice Address - Street 1:3211 N SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3546
Practice Address - Country:US
Practice Address - Phone:414-442-4408
Practice Address - Fax:414-442-4408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129-184163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38-334800Medicaid