Provider Demographics
NPI:1750903464
Name:COWDERY, ALEXUS MCKENNA
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:MCKENNA
Last Name:COWDERY
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 1:210 ISABELLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5214
Mailing Address - Country:US
Mailing Address - Phone:740-618-3276
Mailing Address - Fax:
Practice Address - Street 1:210 ISABELLE RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5214
Practice Address - Country:US
Practice Address - Phone:740-618-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402162860419376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide