Healthcare Provider Details

I. General information

NPI: 1124808795
Provider Name (Legal Business Name): EMILIE R OWENS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILIE R HANSON

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 BALTIMORE PIKE STE B2
SPRINGFIELD PA
19064-3997
US

IV. Provider business mailing address

3803 W CHESTER PIKE STE 160
NEWTOWN SQUARE PA
19073-2336
US

V. Phone/Fax

Practice location:
  • Phone: 484-573-5116
  • Fax:
Mailing address:
  • Phone: 484-337-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP030462
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030462
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: