Healthcare Provider Details

I. General information

NPI: 1669058814
Provider Name (Legal Business Name): LACEE OWINGS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3128 WESTMINSTER ST
MANCHESTER MD
21102-1893
US

IV. Provider business mailing address

PO BOX 7
MANCHESTER MD
21102-0007
US

V. Phone/Fax

Practice location:
  • Phone: 410-374-1414
  • Fax: 410-374-1443
Mailing address:
  • Phone: 410-374-1414
  • Fax: 410-374-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR201473
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: