Healthcare Provider Details

I. General information

NPI: 1083492847
Provider Name (Legal Business Name): ERICA ELLEN COWAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 N COLLEGE AVE
FORT COLLINS CO
80524-2443
US

IV. Provider business mailing address

171 N COLLEGE AVE
FORT COLLINS CO
80524-2443
US

V. Phone/Fax

Practice location:
  • Phone: 970-235-0615
  • Fax:
Mailing address:
  • Phone: 970-235-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number170411
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: