Provider Demographics
NPI:1265009823
Name:OWENS, ROSE M
Entity Type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:M
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:G
Other - Last Name:PIPPINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ETC
Mailing Address - Street 1:117 ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2643
Mailing Address - Country:US
Mailing Address - Phone:937-673-8951
Mailing Address - Fax:937-221-8003
Practice Address - Street 1:117 ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2643
Practice Address - Country:US
Practice Address - Phone:937-673-8951
Practice Address - Fax:937-221-8003
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138594163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0426931Medicaid