Basic Information
| Provider Information | |||||||||
| NPI: | 1629248505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | SHANEE | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 979 E. THIRD STREET | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237788179 | ||||||||
| FaxNumber: | 4237788180 | ||||||||
| Practice Location | |||||||||
| Address1: | 979 E. THIRD STREET | ||||||||
| Address2: | SUITE# B.601 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237788179 | ||||||||
| FaxNumber: | 4237788180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2008 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 70373 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 13255 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 70373 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.