MEDICARE: TONIA RENIA OWENS NURSE

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	163W00000X	Registered Nurse	4704326028	MI

General Provider Information

NPI Number	:	1356041057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA RENIA OWENS NURSE

Provider Business Mailing Address
First Line	:	PO BOX 252313
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48325-2313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5828 CHERRYWOOD APT 2310
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4530
Country	:	US
Telephone Number	:	248-935-1606
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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