| Doctor Name: | MARLISA G. MCGOWAN |
| NPI Number: | 1295119220 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PNP-C |
| License Number: | 2015018288 |
| Business Practice Address: | 120 W 16th St Mountain Grove, MO - 657111039 |
| Business Phone Number: | 4179266111 |
| Business Fax Number: | 4179266115 |
| Mailing Address: | Po Box 505164, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631505164 |
| Phone Number: | 4178294620 |
| Fax Number: | 4178294316 |
| NPI Enumeration Date: | 07/20/2015 |
| NPI Last Update Date: | 11/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 2015018288 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |