Provider Demographics
NPI:1376187476
Name:OWENS, SARDA CHARLOTTE
Entity Type:Individual
Prefix:
First Name:SARDA
Middle Name:CHARLOTTE
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 1:20748 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2829
Mailing Address - Country:US
Mailing Address - Phone:586-265-0880
Mailing Address - Fax:
Practice Address - Street 1:3502 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1735
Practice Address - Country:US
Practice Address - Phone:313-784-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant