Provider Demographics
NPI:1619142619
Name:OWENS, MARIE KATHERINE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:KATHERINE
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 1:933 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3172
Mailing Address - Country:US
Mailing Address - Phone:757-227-4246
Mailing Address - Fax:757-963-5346
Practice Address - Street 1:933 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3172
Practice Address - Country:US
Practice Address - Phone:757-227-4246
Practice Address - Fax:757-963-5346
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006854174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist