1609287184 NPI number — MRS. TRINITY DAWN COWBURN MA, BSL

Table of content: MRS. TRINITY DAWN COWBURN MA, BSL (NPI 1609287184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609287184 NPI number — MRS. TRINITY DAWN COWBURN MA, BSL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWBURN
Provider First Name:
TRINITY
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, BSL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUTLER
Provider Other First Name:
TRINITY
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609287184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLEETWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19522-1323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-944-0445
Provider Business Mailing Address Fax Number:
610-944-8834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 PLAZA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-7142
Provider Business Practice Location Address Fax Number:
570-724-6771
Provider Enumeration Date:
05/19/2014

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: 101Y00000X , with the licence number:  BH001621 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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