Provider Demographics
NPI:1740382589
Name:MCGOWAN, ELIZABETH CAROL (MSN, PHN, RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CAROL
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MSN, PHN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 JACKSON ST
Mailing Address - Street 2:206
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3901
Mailing Address - Country:US
Mailing Address - Phone:951-353-2211
Mailing Address - Fax:951-353-2625
Practice Address - Street 1:1330 N INDIAN CANYON DR
Practice Address - Street 2:SUITE F
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-864-4163
Practice Address - Fax:760-864-4166
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA488533163WG0000X, 163WG0100X
CA13822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q03426Medicare UPIN
CAZZZ21277ZMedicare ID - Type Unspecified