Provider Demographics
NPI:1255388377
Name:JOHNSON-COWLEY, ANDREW C (CRNA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:JOHNSON-COWLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6429 JOSEPHINE AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1422
Mailing Address - Country:US
Mailing Address - Phone:952-913-5368
Mailing Address - Fax:
Practice Address - Street 1:6429 JOSEPHINE AVE
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-1422
Practice Address - Country:US
Practice Address - Phone:952-913-5368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1366235367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN183400200Medicaid