Healthcare Provider Details

I. General information

NPI: 1477845667
Provider Name (Legal Business Name): RENEE ANTONETTE COWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE ANTONETTE WOODBURN MD

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 515
BATON ROUGE LA
70817-5129
US

IV. Provider business mailing address

100 WOMAN'S WAY PHYSICIAN PRACTICE MANAGEMENT
BATON ROUGE LA
70817
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-3006
  • Fax:
Mailing address:
  • Phone: 225-216-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number328024
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: