Healthcare Provider Details

I. General information

NPI: 1649644618
Provider Name (Legal Business Name): DAVID OWENS ACAGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 W 11TH AVE
EUGENE OR
97402-5601
US

IV. Provider business mailing address

1292 HIGH ST STE 224
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-7625
  • Fax:
Mailing address:
  • Phone: 541-500-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN0000020683
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN0000020683
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number201902325NP-PP
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number201902325NP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: