Healthcare Provider Details

I. General information

NPI: 1932618428
Provider Name (Legal Business Name): VONNIQUE OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHESAPEAKE DR STE E
WHITE STONE VA
22578-2656
US

IV. Provider business mailing address

PO BOX 171
WHITE STONE VA
22578-0171
US

V. Phone/Fax

Practice location:
  • Phone: 804-436-7603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: