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Individual

LISA P GOWAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNM

Contact information

Practice address
104 MEDICAL DR, DOTHAN, AL 36303-6902
(334) 671-9445
(334) 671-0059
Mailing address
211 JOHNTOWN RD, OZARK, AL 36360-7517
(334) 237-4644

Taxonomy

Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
1-056034
AL
367A00000X
Advanced Practice Midwife
Primary
1-056034
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
O1056034
MS
Enumeration date
03/14/2010
Last updated
05/05/2015
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