Provider Demographics
NPI:1669878062
Name:OWEN, LISA KAY (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:OWEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1052 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:GILLETT
Mailing Address - State:PA
Mailing Address - Zip Code:16925-8988
Mailing Address - Country:US
Mailing Address - Phone:607-425-9606
Mailing Address - Fax:570-596-7781
Practice Address - Street 1:1052 RANDALL RD
Practice Address - Street 2:
Practice Address - City:GILLETT
Practice Address - State:PA
Practice Address - Zip Code:16925-8988
Practice Address - Country:US
Practice Address - Phone:607-425-9606
Practice Address - Fax:570-596-7781
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212547-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse