Healthcare Provider Details

I. General information

NPI: 1093499261
Provider Name (Legal Business Name): PAMELA OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 W 7TH ST
VICTORIA VA
23974-4522
US

IV. Provider business mailing address

275 K V RD
VICTORIA VA
23974-2612
US

V. Phone/Fax

Practice location:
  • Phone: 804-366-9261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: