Healthcare Provider Details

I. General information

NPI: 1811253446
Provider Name (Legal Business Name): DANNA MARIE OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANNA MARIE ARNOLD

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 4TH ST NW SUITEF-4
LOS RANCHOS NM
87107-5800
US

IV. Provider business mailing address

707 BROADWAY BLVD NE SUITE 500
ALBUQUERQUE NM
87102-2360
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-9641
  • Fax: 505-344-2621
Mailing address:
  • Phone: 505-268-0717
  • Fax: 505-232-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: