Provider Demographics
NPI:1285183640
Name:OWENS, NICOLE (342421050306E)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:342421050306E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 ELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-5230
Mailing Address - Country:US
Mailing Address - Phone:585-719-7784
Mailing Address - Fax:
Practice Address - Street 1:68 ELWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-5230
Practice Address - Country:US
Practice Address - Phone:585-719-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342421050306E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide