Provider Demographics
NPI:1396731030
Name:OWENS, NANCY L (RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:OWENS
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17700 W SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1448
Mailing Address - Country:US
Mailing Address - Phone:616-846-7535
Mailing Address - Fax:
Practice Address - Street 1:1091 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2607
Practice Address - Country:US
Practice Address - Phone:616-604-0096
Practice Address - Fax:616-604-0095
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704097658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4682052-10Medicaid
MINO097658OtherBLUE CROSS BLUE SHIELD
MIP07630004Medicare ID - Type Unspecified
MINO097658OtherBLUE CROSS BLUE SHIELD