Healthcare Provider Details

I. General information

NPI: 1447072483
Provider Name (Legal Business Name): REID OWENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 BEN FRANKLIN BLVD
DURHAM NC
27704-2140
US

IV. Provider business mailing address

3204 WILDER ST
RALEIGH NC
27607-5262
US

V. Phone/Fax

Practice location:
  • Phone: 919-972-7700
  • Fax: 919-972-7712
Mailing address:
  • Phone: 919-802-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number234318
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: