Healthcare Provider Details

I. General information

NPI: 1104255892
Provider Name (Legal Business Name): CHRISTOPHER COWLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE 673 MDG
JBER AK
99506
US

IV. Provider business mailing address

1650 COWLES ST
FAIRBANKS AK
99701-5907
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-1815
  • Fax:
Mailing address:
  • Phone: 907-458-3629
  • Fax: 907-458-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number434
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: