Provider Demographics
NPI:1770595548
Name:OWENS, ALISE OTT (FNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:ALISE
Middle Name:OTT
Last Name:OWENS
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:ALISE
Other - Middle Name:OTT
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC, APRN
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:877-686-0031
Mailing Address - Fax:319-356-3949
Practice Address - Street 1:100 HAWKINS DR STE 213
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1032
Practice Address - Country:US
Practice Address - Phone:877-686-0031
Practice Address - Fax:319-356-3949
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA174356363L00000X, 363LP0200X
SC1467363LF0000X
TX766456363LF0000X
WAAP60400441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863094OtherBCBS OF SC
SCNP0548Medicaid
SCP43140Medicare UPIN
SC576007863094OtherBCBS OF SC