Healthcare Provider Details

I. General information

NPI: 1013841964
Provider Name (Legal Business Name): MYESHIA OWTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 FOREST COVE DR APT 110
MOUNT PROSPECT IL
60056-5413
US

IV. Provider business mailing address

1721 FOREST COVE DR APT 110
MOUNT PROSPECT IL
60056-5413
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-2268
  • Fax:
Mailing address:
  • Phone: 773-726-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.010947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: