Provider Demographics
NPI:1669470373
Name:OWENS, MICHELLE MCDANIEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MCDANIEL
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:MICHELLE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:423 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4527
Mailing Address - Country:US
Mailing Address - Phone:337-785-9922
Mailing Address - Fax:
Practice Address - Street 1:527 ODD FELLOWS RD STE B
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2208
Practice Address - Country:US
Practice Address - Phone:337-785-2006
Practice Address - Fax:337-785-2016
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12971R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1555029Medicaid
LA1555029Medicaid
LA5E530Medicare ID - Type Unspecified