MEDICARE: MS. SALLY ANN OWENS RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	186910	CO

General Provider Information

NPI Number	:	1831429125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY ANN OWENS RN, BSN

Provider Business Mailing Address
First Line	:	600 RAINTREE BLVD LOT 108
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-2175
Country	:	US
Telephone Number	:	719-248-6537
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 RAINTREE BLVD LOT 108
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-2175
Country	:	US
Telephone Number	:	719-248-6537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2010
Last Update Date	:	08/02/2021

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