Healthcare Provider Details

I. General information

NPI: 1841787629
Provider Name (Legal Business Name): EMILY GRACE OWEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E COMMERCIAL AVE
ANACONDA MT
59711-2718
US

IV. Provider business mailing address

625 EUGENIA AVE
MADISON WI
53705-3404
US

V. Phone/Fax

Practice location:
  • Phone: 406-583-8689
  • Fax:
Mailing address:
  • Phone: 360-689-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72549-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: