1053328195 NPI number — MRS. ADRIENNE VAN ERP COWAN OTR/L

Table of content: MRS. ADRIENNE VAN ERP COWAN OTR/L (NPI 1053328195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053328195 NPI number — MRS. ADRIENNE VAN ERP COWAN OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWAN
Provider First Name:
ADRIENNE
Provider Middle Name:
VAN ERP
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRATT
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
V.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053328195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W. OLLIE
Provider Second Line Business Mailing Address:
SCOTT & WHITE HOSPITAL
Provider Business Mailing Address City Name:
LLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-388-8246
Provider Business Mailing Address Fax Number:
325-388-6235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 FM 2342
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-388-8246
Provider Business Practice Location Address Fax Number:
325-388-6235
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  107948 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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