Provider Demographics
NPI:1952341182
Name:OWENS, MICHELLE RENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENE
Last Name:OWENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCXE III 1650 COCHRANE CIRCLE
Mailing Address - Street 2:USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL ATTN MS RANKIN
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-7649
Mailing Address - Fax:719-526-7019
Practice Address - Street 1:GENERAL SURGERY CLINIC
Practice Address - Street 2:USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-559-9288
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43301164W00000X
MO056200164W00000X
OHPRO100642164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse