Provider Demographics
NPI:1972576361
Name:GOWEN, DEBORAH (CNM)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GOWEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MASS AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6731
Mailing Address - Country:US
Mailing Address - Phone:781-643-7020
Mailing Address - Fax:
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:STE 102
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-646-1043
Practice Address - Fax:781-646-2591
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164514176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0359220Medicaid
MAS33945Medicare UPIN
MA0359220Medicaid