Provider Demographics
NPI:1720384746
Name:COWAN, ROSE ANN (MA, ST)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANN
Last Name:COWAN
Suffix:
Gender:F
Credentials:MA, ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 12TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5291
Mailing Address - Country:US
Mailing Address - Phone:253-359-8686
Mailing Address - Fax:
Practice Address - Street 1:13114 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3014
Practice Address - Country:US
Practice Address - Phone:425-821-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAST 60140761246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist