Provider Demographics
NPI:1891018024
Name:OWENS, DEREK LAWRENCE (CRNA)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LAWRENCE
Last Name:OWENS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:
Practice Address - Street 1:1801 COLORADO AVE STE 140
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2711
Practice Address - Country:US
Practice Address - Phone:209-216-3470
Practice Address - Fax:209-216-3475
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL516784146L00000X
CA650398163W00000X
AZ260373367500000X
CA3897367500000X
FL9197186367500000X
VA0024184265367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163W00000XNursing Service ProvidersRegistered Nurse