Basic Information
Provider Information
NPI: 1295292902
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OWENS
FirstName: LINDA
MiddleName: ALLISON
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 29681 ARMADA RIDGE RD
Address2:  
City: RICHMOND
State: MI
PostalCode: 480624524
CountryCode: US
TelephoneNumber: 5864536348
FaxNumber:  
Practice Location
Address1: 2255 S LINDEN RD
Address2:  
City: FLINT
State: MI
PostalCode: 485325417
CountryCode: US
TelephoneNumber: 8107328087
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/28/2019
LastUpdateDate: 02/28/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WH0200X4704131402MIY Nursing Service ProvidersRegistered NurseHome Health

No ID Information.


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