Provider Demographics
NPI:1275096372
Name:STRONG, OWEN
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:STRONG
Suffix:
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 1:310 OPEN RANGE AVE SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6389
Mailing Address - Country:US
Mailing Address - Phone:505-353-6408
Mailing Address - Fax:
Practice Address - Street 1:310 OPEN RANGE AVE SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6389
Practice Address - Country:US
Practice Address - Phone:505-353-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM23448164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse