Provider Demographics
NPI:1982345146
Name:OWENS, CHYVIA L
Entity Type:Individual
Prefix:
First Name:CHYVIA
Middle Name:L
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-1127
Mailing Address - Country:US
Mailing Address - Phone:262-237-9797
Mailing Address - Fax:
Practice Address - Street 1:6130 12TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-1127
Practice Address - Country:US
Practice Address - Phone:262-237-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374J00000X
WI327705164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374J00000XNursing Service Related ProvidersDoula