Healthcare Provider Details

I. General information

NPI: 1013066141
Provider Name (Legal Business Name): ALEIA LAVONNE COWAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 NE SISKIYOU ST
PORTLAND OR
97212-2471
US

IV. Provider business mailing address

34721 HIGHWAY 105
ASTORIA OR
97103-6637
US

V. Phone/Fax

Practice location:
  • Phone: 503-528-0757
  • Fax: 503-528-0764
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: