MEDICARE: MADELINE HALL OWEN

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	363L00000X	Nurse Practitioner	5024615	NC

General Provider Information

NPI Number	:	1629812144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE HALL OWEN

Provider Business Mailing Address
First Line	:	2630 WILLARD DAIRY RD STE 303
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8354
Country	:	US
Telephone Number	:	336-884-3742
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 WILLARD DAIRY RD STE 303
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8354
Country	:	US
Telephone Number	:	336-884-3742
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/07/2026

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