Healthcare Provider Details

I. General information

NPI: 1609011261
Provider Name (Legal Business Name): CRYSTAL D COWAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL D TYMUS FNP-BC

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BRANDING AVE STE 310
DOWNERS GROVE IL
60515-5624
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 630-829-1038
  • Fax: 630-829-1080
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3599-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.034423
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number3599
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: