Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 300080 | NY |
NPI | 1013023308 |
---|---|
Provider Name | Janet L Owen |
First Address | Seneca Falls, NY 13148-0554 |
Second Address | Waterloo, NY 13165-1643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S 28222 | (02) | NY |