Provider Demographics
NPI:1336897370
Name:GOWEN, THOMAS FANCIS JR (RN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:FANCIS
Last Name:GOWEN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 ELTON ST
Mailing Address - Street 2:
Mailing Address - City:GRANTWOOD VLG
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3806
Mailing Address - Country:US
Mailing Address - Phone:314-598-2867
Mailing Address - Fax:
Practice Address - Street 1:272 MAYFAIR PLAZA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-8009
Practice Address - Country:US
Practice Address - Phone:314-859-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO136999163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology