MEDICARE: JOHNNA M COWIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	200747	NC
2	363LW0102X	Women's Health Nurse Practitioner	200747	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972580223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNA M COWIN FNP

Provider Business Mailing Address
First Line	:	2100 STANTONSBURG RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 BROWN ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4671
Country	:	US
Telephone Number	:	252-946-6544
Fax Number	:	252-975-6540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	11/14/2023

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