Provider Demographics
NPI:1215380803
Name:OWENS, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SE EVERETT MALLWAY
Mailing Address - Street 2:APT 1217
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 SE EVERETT MALL WAY
Practice Address - Street 2:APT 1217
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3204
Practice Address - Country:US
Practice Address - Phone:312-522-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility