Provider Demographics
NPI:1962423533
Name:MC COWAN, LESLIE A (RN, GNP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:MC COWAN
Suffix:
Gender:F
Credentials:RN, GNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, GNP
Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:MEDICAL PLAZA II, SUITE 4-450
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1573
Mailing Address - Country:US
Mailing Address - Phone:303-825-1234
Mailing Address - Fax:720-321-8121
Practice Address - Street 1:11700 W 2ND PL
Practice Address - Street 2:MEDICAL PLAZA II, SUITE 4-450
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1573
Practice Address - Country:US
Practice Address - Phone:303-825-1234
Practice Address - Fax:720-321-8121
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71309363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS35316Medicare UPIN
CO07713092Medicare ID - Type Unspecified