Individual
SAMANTHA NISSI COWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
420 SOONER DR, BURNS FLAT, OK 73624-0569
(580) 562-4882
(580) 562-4880
Mailing address
PO BOX 569, BURNS FLAT, OK 73624-0569
(580) 562-4882
(580) 562-4880
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982861134
—
OK
Enumeration date
07/22/2022
Last updated
07/22/2022
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