Healthcare Provider Details

I. General information

NPI: 1407289424
Provider Name (Legal Business Name): EUGENIA OWENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 DAMASCUS AVE
SPRINGFIELD OH
45506-3001
US

IV. Provider business mailing address

635 DAMASCUS AVE
SPRINGFIELD OH
45506-3001
US

V. Phone/Fax

Practice location:
  • Phone: 937-717-4078
  • Fax:
Mailing address:
  • Phone: 937-717-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number332233
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number332233
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: