Provider Demographics
NPI:1669022729
Name:OWEN, MARYBETH E
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:E
Last Name:OWEN
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 1:12 BROOKLYN STREET
Mailing Address - Street 2:
Mailing Address - City:ARROW
Mailing Address - State:NY
Mailing Address - Zip Code:14001
Mailing Address - Country:US
Mailing Address - Phone:716-542-4246
Mailing Address - Fax:
Practice Address - Street 1:12 BROOKLYN STREET
Practice Address - Street 2:
Practice Address - City:ARROW
Practice Address - State:NY
Practice Address - Zip Code:14001
Practice Address - Country:US
Practice Address - Phone:716-542-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider