MEDICARE: MONIQUETTA OWENS NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	2015023416	MO
2	363LF0000X	Family Nurse Practitioner	2015023416	MO

General Provider Information

NPI Number	:	1295119717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUETTA OWENS NP-C

Provider Business Mailing Address
First Line	:	1241 E DYER RD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 E DYER RD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5611
Country	:	US
Telephone Number	:	816-724-9194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	11/22/2015

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