Provider Demographics
NPI:1366698789
Name:COGSWELL, LISA M (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:COGSWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2200 GREEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2948
Mailing Address - Country:US
Mailing Address - Phone:734-994-7446
Mailing Address - Fax:734-623-8590
Practice Address - Street 1:2200 GREEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2948
Practice Address - Country:US
Practice Address - Phone:734-994-7446
Practice Address - Fax:734-623-8590
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243632363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care