Provider Demographics
NPI:1831429125
Name:OWENS, SALLY ANN (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:OWENS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RAINTREE BLVD LOT 108
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2175
Mailing Address - Country:US
Mailing Address - Phone:719-248-6537
Mailing Address - Fax:
Practice Address - Street 1:600 RAINTREE BLVD LOT 108
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2175
Practice Address - Country:US
Practice Address - Phone:719-248-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO186910163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse