Provider Demographics
NPI:1013023308
Name:OWEN, JANET L (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:OWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-0554
Mailing Address - Country:US
Mailing Address - Phone:315-568-2541
Mailing Address - Fax:
Practice Address - Street 1:367 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1643
Practice Address - Country:US
Practice Address - Phone:315-539-0580
Practice Address - Fax:315-539-0583
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300080363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS 28222Medicare UPIN
NYF300080-1Medicare ID - Type Unspecified