Healthcare Provider Details

I. General information

NPI: 1982674172
Provider Name (Legal Business Name): VIKKI OWEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 AUTUMN RUN DR
MAINEVILLE OH
45039-5074
US

IV. Provider business mailing address

1156 AUTUMN RUN DR
MAINEVILLE OH
45039-5074
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: