Provider Demographics
NPI:1487010237
Name:OWEN, LINDA RAE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:RAE
Last Name:OWEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-0729
Mailing Address - Country:US
Mailing Address - Phone:575-354-0057
Mailing Address - Fax:505-354-0056
Practice Address - Street 1:405 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:CAPITAN
Practice Address - State:NM
Practice Address - Zip Code:88316
Practice Address - Country:US
Practice Address - Phone:575-354-0057
Practice Address - Fax:575-354-0056
Is Sole Proprietor?:No
Enumeration Date:2016-01-10
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02755363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily