Healthcare Provider Details

I. General information

NPI: 1225062946
Provider Name (Legal Business Name): DEBORAH HERN OWEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 160
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

420 N 2ND AVE SUITE 200
SANDPOINT ID
83864-1552
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax:
Mailing address:
  • Phone: 208-263-2173
  • Fax: 208-263-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60223685
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM8203
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: