Basic Information
| Provider Information | |||||||||
| NPI: | 1952341182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | RENE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | MCXE III 1650 COCHRANE CIRCLE | ||||||||
| Address2: | USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL ATTN MS RANKIN | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267649 | ||||||||
| FaxNumber: | 7195267019 | ||||||||
| Practice Location | |||||||||
| Address1: | GENERAL SURGERY CLINIC | ||||||||
| Address2: | USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195599288 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 43301 | CO | Y | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | 056200 | MO | N | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | PRO100642 | OH | N | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.