Provider Demographics
NPI:1215066022
Name:OWEN, ANITA MAE (LPN)
Entity type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:MAE
Last Name:OWEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:FEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45119-0156
Mailing Address - Country:US
Mailing Address - Phone:937-375-1414
Mailing Address - Fax:
Practice Address - Street 1:7646 LOVE RD
Practice Address - Street 2:
Practice Address - City:HAMERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45130-8744
Practice Address - Country:US
Practice Address - Phone:937-375-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.103159164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse