Provider Demographics
NPI:1780614040
Name:OWEN, SUE B (CNM)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:B
Last Name:OWEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:1 AMALIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2239
Mailing Address - Country:US
Mailing Address - Phone:304-472-7473
Mailing Address - Fax:304-472-0533
Practice Address - Street 1:1 AMALIA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2239
Practice Address - Country:US
Practice Address - Phone:304-472-7473
Practice Address - Fax:304-472-0533
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV124367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVOWNM03231Medicare PIN