Provider Demographics
NPI:1639436538
Name:CHU, OWENA ELIZABETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:OWENA
Middle Name:ELIZABETH
Last Name:CHU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-1515
Mailing Address - Country:US
Mailing Address - Phone:909-744-9451
Mailing Address - Fax:909-744-9453
Practice Address - Street 1:29099 HOSPITAL ROAD, SUITE 204
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-4816
Practice Address - Country:US
Practice Address - Phone:909-744-9451
Practice Address - Fax:909-744-9453
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA319375163W00000X
CA21720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse