Healthcare Provider Details

I. General information

NPI: 1275599482
Provider Name (Legal Business Name): MATTHEW HARMER COWELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
FT CARSON CO
80913-4604
US

IV. Provider business mailing address

914 OLD RANCH RD
FLORISSANT CO
80816-9070
US

V. Phone/Fax

Practice location:
  • Phone: 719-290-1186
  • Fax:
Mailing address:
  • Phone: 719-290-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number83701
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number42795
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: