Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 093641 | MO |
NPI | 1073834271 |
---|---|
Provider Name | Mary A. Cowan |
First Address | Lees Summit, MO 64086-6001 |
Second Address | Lees Summit, MO 64086-6001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 01/09/2021 |