Provider Demographics
NPI:1164459483
Name:OWENS, DOROTHA C II
Entity Type:Individual
Prefix:
First Name:DOROTHA
Middle Name:C
Last Name:OWENS
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W CORK ST
Mailing Address - Street 2:#450
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3870
Mailing Address - Country:US
Mailing Address - Phone:540-536-5210
Mailing Address - Fax:540-686-7961
Practice Address - Street 1:333 W CORK ST
Practice Address - Street 2:#450
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-5210
Practice Address - Fax:540-686-7961
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner