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NPI Code Detail

MEDICARE: MRS. MARTHA ANN COWGER MSN,FNP-BC

MEDICARE: MRS. MARTHA ANN COWGER MSN,FNP-BC
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
1363LF0000XFamily Nurse Practitioner53390WV

General Provider Information

NPI Number : 1790013092
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARTHA ANN COWGER MSN,FNP-BC
Provider Business Mailing Address
First Line : 111 MONTEREY LN
Second Line :
City : CROSS LANES
State : WV
Zip : 25313-2603
Country : US
Telephone Number : 304-545-5340
Fax Number : 304-343-7009
Provider Business Practice Location Address
First Line : 1520 WASHINGTON ST E
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-2511
Country : US
Telephone Number : 304-414-5930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2009
Last Update Date : 11/24/2009

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