Provider Demographics
NPI:1174145346
Name:CYRUS, JOWANA ELAINE
Entity type:Individual
Prefix:MISS
First Name:JOWANA
Middle Name:ELAINE
Last Name:CYRUS
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:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-0630
Mailing Address - Country:US
Mailing Address - Phone:651-413-5165
Mailing Address - Fax:651-342-1384
Practice Address - Street 1:1621 ORLEANS ST W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7577
Practice Address - Country:US
Practice Address - Phone:612-558-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide