Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 725948 | TX |
NPI | 1073860086 |
---|---|
Provider Name | Tomora Joell Owens |
First Address | Chantilly, VA 20151-1647 |
Second Address | Houston, TX 77047-2527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 04/07/2016 |