Provider Demographics
NPI:1356096697
Name:OWENS, VIRGINIA LOUISE BROWN
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LOUISE BROWN
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 1:1908 N BEALE RD STE E1908N
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6937
Mailing Address - Country:US
Mailing Address - Phone:530-743-6888
Mailing Address - Fax:530-743-9823
Practice Address - Street 1:1908 N BEALE RD STE E
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6937
Practice Address - Country:US
Practice Address - Phone:530-743-6888
Practice Address - Fax:530-743-9823
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018104363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty