Provider Demographics
NPI:1750103628
Name:COWAN, CEARIRA S
Entity type:Individual
Prefix:
First Name:CEARIRA
Middle Name:S
Last Name:COWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BLACK ROCK SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021-9544
Mailing Address - Country:US
Mailing Address - Phone:980-925-3476
Mailing Address - Fax:
Practice Address - Street 1:316 BLACK ROCK SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-9544
Practice Address - Country:US
Practice Address - Phone:980-925-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-036-419372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion