Provider Demographics
NPI:1396217303
Name:OWENS, NICHOLAS
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 ROBERT E LEE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23860-7529
Mailing Address - Country:US
Mailing Address - Phone:804-439-1264
Mailing Address - Fax:
Practice Address - Street 1:4111 ROBERT E LEE DR
Practice Address - Street 2:
Practice Address - City:NORTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23860-7529
Practice Address - Country:US
Practice Address - Phone:804-439-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate