Healthcare Provider Details

I. General information

NPI: 1629812144
Provider Name (Legal Business Name): MADELINE HALL OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 WILLARD DAIRY RD STE 303
HIGH POINT NC
27265-8354
US

IV. Provider business mailing address

2630 WILLARD DAIRY RD STE 303
HIGH POINT NC
27265-8354
US

V. Phone/Fax

Practice location:
  • Phone: 336-884-3742
  • Fax:
Mailing address:
  • Phone: 336-884-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024615
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: