Provider Demographics
NPI:1790381010
Name:COWAN, ANTHONY HERBERT (LPN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:HERBERT
Last Name:COWAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N COOK RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4520
Mailing Address - Country:US
Mailing Address - Phone:765-729-8618
Mailing Address - Fax:
Practice Address - Street 1:208 N COOK RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4520
Practice Address - Country:US
Practice Address - Phone:765-729-8618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27066612A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse