Provider Demographics
NPI:1184379018
Name:OWEN, TRACI A (RN, CSC, SE)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:A
Last Name:OWEN
Suffix:
Gender:F
Credentials:RN, CSC, SE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2297 N 9TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2890
Mailing Address - Country:US
Mailing Address - Phone:918-283-7130
Mailing Address - Fax:539-367-2412
Practice Address - Street 1:2297 N 9TH ST STE 121
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2890
Practice Address - Country:US
Practice Address - Phone:918-283-7130
Practice Address - Fax:539-367-2412
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0051306163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse