Provider Demographics
NPI:1063481315
Name:COWLES, SUSAN F (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:COWLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7905
Mailing Address - Country:US
Mailing Address - Phone:970-330-8335
Mailing Address - Fax:970-350-4930
Practice Address - Street 1:1901 10TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-5545
Practice Address - Country:US
Practice Address - Phone:970-350-4930
Practice Address - Fax:970-350-4953
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO58157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner