Provider Demographics
NPI:1134667538
Name:COWART, UMECCA DIANE (CNP)
Entity type:Individual
Prefix:
First Name:UMECCA
Middle Name:DIANE
Last Name:COWART
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 NEWPORT WAY
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4171
Mailing Address - Country:US
Mailing Address - Phone:313-207-5134
Mailing Address - Fax:
Practice Address - Street 1:2400 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1152
Practice Address - Country:US
Practice Address - Phone:419-442-7701
Practice Address - Fax:419-225-8878
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704277432363LG0600X
CA95024912363LF0000X
OHAPRN.CNP.022132363LF0000X
TX1020807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology