Provider Demographics
NPI:1669746152
Name:OWENS, ANTONY DOMINICK (CNA)
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:DOMINICK
Last Name:OWENS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 WINTON RD S
Mailing Address - Street 2:A24
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5902
Mailing Address - Country:US
Mailing Address - Phone:585-350-6026
Mailing Address - Fax:
Practice Address - Street 1:3230 WINTON RD S
Practice Address - Street 2:A24
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5902
Practice Address - Country:US
Practice Address - Phone:585-350-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342876901009376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide