Basic Information
| Provider Information | |||||||||
| NPI: | 1740696160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4260 BROADWAY | ||||||||
| Address2: | APT. 603 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062403055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 E 183RD ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104531242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188398900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2014 | ||||||||
| LastUpdateDate: | 01/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN60376459 | WA | N | Nursing Service Providers | Registered Nurse | 163WG0000X | 694998 | NY | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | 339301 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.