Healthcare Provider Details

I. General information

NPI: 1881281335
Provider Name (Legal Business Name): ELIZABETH COWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S. CLINTON AVE BUILDING H, SUITE 135
ROCHESTER NY
14618
US

IV. Provider business mailing address

2400 S. CLINTON AVE BUILDING H, SUITE 135
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7066
  • Fax:
Mailing address:
  • Phone: 585-341-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number672838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: