MEDICARE: HEATHER OWENS LLC

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	208000000X	Pediatrics Physician	MD2015-0823	NM

General Provider Information

NPI Number	:	1700251824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHER OWENS LLC

Provider Business Mailing Address
First Line	:	4181 CAMINO COYOTE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-7096
Country	:	US
Telephone Number	:	575-532-6006
Fax Number	:	575-932-9049

Provider Business Practice Location Address
First Line	:	4181 CAMINO COYOTE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-7096
Country	:	US
Telephone Number	:	575-532-6006
Fax Number	:	575-932-9049

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HEATHER OWENS
Credential	:	MD
Telephone Number	:	707-227-6467

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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Directions to “HEATHER OWENS LLC ” Practice Location

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