Healthcare Provider Details

I. General information

NPI: 1598424913
Provider Name (Legal Business Name): AMANDA LYNN-GRACE DONNELLY-COWEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 ROCKSIDE WOODS BLVD S STE 330
INDEPENDENCE OH
44131-2222
US

IV. Provider business mailing address

4221 SCHOOL RD
TEMPERANCE MI
48182-9755
US

V. Phone/Fax

Practice location:
  • Phone: 855-490-9434
  • Fax: 216-238-9526
Mailing address:
  • Phone: 419-704-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030237
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704309051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: