MEDICARE: MRS. DIANE M COWELL RNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	524556	TX

General Provider Information

NPI Number	:	1376531756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE M COWELL RNC

Provider Business Mailing Address
First Line	:	PSC 47 BOX 2129
Second Line	:
City	:	APO
State	:	AE
Zip	:	09470
Country	:	US
Telephone Number	:	441480844504
Fax Number	:

Provider Business Practice Location Address
First Line	:	RAF UPWWOD CLINIC
Second Line	:
City	:	APO
State	:	AE
Zip	:	09470
Country	:	US
Telephone Number	:	441480844504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/21/2022

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