Provider Demographics
NPI:1720820095
Name:OWEN, ALYSSA JAMIE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JAMIE
Last Name:OWEN
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 1:1906 CHURCHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9100
Mailing Address - Country:US
Mailing Address - Phone:714-944-5511
Mailing Address - Fax:
Practice Address - Street 1:1906 CHURCHILL BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9100
Practice Address - Country:US
Practice Address - Phone:714-944-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula