Healthcare Provider Details

I. General information

NPI: 1700020211
Provider Name (Legal Business Name): SIDNEY LEE COWAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 W FIREWEED LN STE 160
ANCHORAGE AK
99503-2561
US

IV. Provider business mailing address

670 W FIREWEED LN STE 160
ANCHORAGE AK
99503-2561
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax: 884-845-1120
Mailing address:
  • Phone: 907-770-0862
  • Fax: 884-845-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberNURR11105
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: