Provider Demographics
NPI:1891291217
Name:COWEN, MELISSA (RN, BSN, MPH, CDE)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:COWEN
Suffix:
Gender:F
Credentials:RN, BSN, MPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HAYNES STREET
Mailing Address - Street 2:DSMP, 2ND FLOOR
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-647-6824
Mailing Address - Fax:860-533-3417
Practice Address - Street 1:71 HAYNES STREET
Practice Address - Street 2:DSMP, 2ND FLOOR
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-647-6824
Practice Address - Fax:860-533-3417
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE52021163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator