Provider Demographics
NPI:1871918250
Name:COWLES ASSAM, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:COWLES ASSAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 COUNTY ROAD 2500 E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:IL
Mailing Address - Zip Code:61738-9263
Mailing Address - Country:US
Mailing Address - Phone:309-531-9662
Mailing Address - Fax:
Practice Address - Street 1:1549 COUNTY ROAD 2500 E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:IL
Practice Address - Zip Code:61738-9263
Practice Address - Country:US
Practice Address - Phone:309-531-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty