Provider Demographics
NPI:1255635991
Name:COWAN, COURTNEY (APN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27555 DIEHL RD
Mailing Address - Street 2:ENTRANCE B
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3849
Mailing Address - Country:US
Mailing Address - Phone:630-646-3950
Mailing Address - Fax:630-548-6832
Practice Address - Street 1:3540 SEVEN BRIDGES DRIVE
Practice Address - Street 2:STE 230
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1222
Practice Address - Country:US
Practice Address - Phone:630-964-9400
Practice Address - Fax:630-964-9375
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008555363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health