Healthcare Provider Details

I. General information

NPI: 1679987408
Provider Name (Legal Business Name): MAUREEN A COWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN A CUNNINGHAM

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 02/21/2023
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE FL 4
PHOENIX AZ
85027-3250
US

IV. Provider business mailing address

20414 N 27TH AVE
PHOENIX AZ
85027-3250
US

V. Phone/Fax

Practice location:
  • Phone: 952-703-5098
  • Fax: 855-848-5268
Mailing address:
  • Phone: 602-370-5914
  • Fax: 615-425-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN136378
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP566
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: