Healthcare Provider Details

I. General information

NPI: 1316224454
Provider Name (Legal Business Name): COWAN GERIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10377 TRAIL HILL LN
CORDOVA TN
38016-6670
US

IV. Provider business mailing address

PO BOX 41784
MEMPHIS TN
38174-1784
US

V. Phone/Fax

Practice location:
  • Phone: 901-289-0564
  • Fax:
Mailing address:
  • Phone: 901-289-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN147062
License Number StateTN

VIII. Authorized Official

Name: ANESHA M COWAN
Title or Position: OWNER
Credential: FNP
Phone: 901-289-0564