Provider Demographics
NPI:1972934990
Name:OWENS, TARA
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
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 1:5206 SPINNING WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-4228
Mailing Address - Country:US
Mailing Address - Phone:810-922-9695
Mailing Address - Fax:
Practice Address - Street 1:5206 SPINNING WHEEL DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-4228
Practice Address - Country:US
Practice Address - Phone:810-922-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-01
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704296571163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics