Provider Demographics
NPI:1104374032
Name:OWENS, JAMIE BETH (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:BETH
Last Name:OWENS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MERCER ST
Mailing Address - Street 2:1A
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3402
Mailing Address - Country:US
Mailing Address - Phone:203-417-5961
Mailing Address - Fax:
Practice Address - Street 1:116 MERCER ST
Practice Address - Street 2:1A
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3402
Practice Address - Country:US
Practice Address - Phone:203-417-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-42212163WL0100X
NY604614-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse