Healthcare Provider Details

I. General information

NPI: 1881460129
Provider Name (Legal Business Name): STEPHANIE TAYLOR OWENS DNP, APRN, FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4475
  • Fax: 505-272-7299
Mailing address:
  • Phone: 505-272-4475
  • Fax: 505-272-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76142
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: