1598424913 NPI number — MS. AMANDA LYNN-GRACE DONNELLY-COWEN FNP-C

Table of content: MS. AMANDA LYNN-GRACE DONNELLY-COWEN FNP-C (NPI 1598424913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598424913 NPI number — MS. AMANDA LYNN-GRACE DONNELLY-COWEN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONNELLY-COWEN
Provider First Name:
AMANDA
Provider Middle Name:
LYNN-GRACE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598424913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4221 SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPERANCE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48182-9755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-704-7200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6480 ROCKSIDE WOODS BLVD S STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-490-9434
Provider Business Practice Location Address Fax Number:
216-238-9526
Provider Enumeration Date:
12/13/2021

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: 363LF0000X , with the licence number:  APRN.CNP.0030237 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 4704309051 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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