Provider Demographics
NPI:1417589474
Name:OWEN, ELISABETH ANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANNE
Last Name:OWEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 INDIAN CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1108
Mailing Address - Country:US
Mailing Address - Phone:256-759-0182
Mailing Address - Fax:
Practice Address - Street 1:810 FRANKLIN ST SE STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4310
Practice Address - Country:US
Practice Address - Phone:256-533-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123103163WN0300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WN0300XNursing Service ProvidersRegistered NurseNephrology