Provider Demographics
NPI:1215115415
Name:MCGOWAN, CHENEY DIANE (LMP)
Entity type:Individual
Prefix:MRS
First Name:CHENEY
Middle Name:DIANE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 AVENUE A
Mailing Address - Street 2:SUITE B
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2926
Mailing Address - Country:US
Mailing Address - Phone:206-819-2540
Mailing Address - Fax:360-568-0876
Practice Address - Street 1:116 AVENUE A
Practice Address - Street 2:SUITE B
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2926
Practice Address - Country:US
Practice Address - Phone:206-819-2540
Practice Address - Fax:360-568-0876
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist