Provider Demographics
NPI:1902212277
Name:OWENS, JERRI L (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:JERRI
Middle Name:L
Last Name:OWENS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 CASHWELL DR # 153
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4302
Mailing Address - Country:US
Mailing Address - Phone:919-946-8205
Mailing Address - Fax:
Practice Address - Street 1:2822 CASHWELL DR # 153
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4302
Practice Address - Country:US
Practice Address - Phone:919-946-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC080313163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant