Provider Demographics
NPI:1346940863
Name:OWENS, HEAVENLEE ANGEL JEAN
Entity Type:Individual
Prefix:
First Name:HEAVENLEE
Middle Name:ANGEL JEAN
Last Name:OWENS
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 1:622 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543-1242
Mailing Address - Country:US
Mailing Address - Phone:419-212-6336
Mailing Address - Fax:
Practice Address - Street 1:622 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543-1242
Practice Address - Country:US
Practice Address - Phone:419-212-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide