Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 240319 | NC |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1-102656 | AL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 240319 | NC |
NPI | 1770823916 |
---|---|
Provider Name | Mrs. Japonica Dorcel Owens |
First Address | Pinehurst, NC 28374-8710 |
Second Address | Pinehurst, NC 28374-8710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2013 |
Last Update Date | 28/02/2019 |