Provider Demographics
NPI:1922171792
Name:OWENS, JEREMY MICHEAL
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHEAL
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ROUNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7711
Mailing Address - Country:US
Mailing Address - Phone:731-336-6367
Mailing Address - Fax:
Practice Address - Street 1:508 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7711
Practice Address - Country:US
Practice Address - Phone:731-336-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other