Healthcare Provider Details

I. General information

NPI: 1720384746
Provider Name (Legal Business Name): ROSE ANN COWAN MA, ST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13114 120TH AVE NE
KIRKLAND WA
98034-3014
US

IV. Provider business mailing address

301 12TH ST NW
PUYALLUP WA
98371-5291
US

V. Phone/Fax

Practice location:
  • Phone: 425-821-6000
  • Fax:
Mailing address:
  • Phone: 253-359-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberST 60140761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: