Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 22HI01023500 | NJ |
NPI | 1043621188 |
---|---|
Provider Name | Kiwuna Owens |
First Address | Bridgeton, NJ 08302-1946 |
Second Address | Bridgeton, NJ 08302-2139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 12/05/2014 |