Healthcare Provider Details

I. General information

NPI: 1417448804
Provider Name (Legal Business Name): ASHLEY OWENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2310
US

IV. Provider business mailing address

8800 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2310
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6400
  • Fax:
Mailing address:
  • Phone: 505-462-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number79077
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: