Healthcare Provider Details

I. General information

NPI: 1740382589
Provider Name (Legal Business Name): ELIZABETH CAROL MCGOWAN MSN, PHN, RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N INDIAN CANYON DR SUITE F
PALM SPRINGS CA
92262-4880
US

IV. Provider business mailing address

3975 JACKSON ST 206
RIVERSIDE CA
92503-3901
US

V. Phone/Fax

Practice location:
  • Phone: 760-864-4163
  • Fax: 760-864-4166
Mailing address:
  • Phone: 951-353-2211
  • Fax: 951-353-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number488533
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number488533
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: