Provider Demographics
NPI:1902884471
Name:OWEN, SUE WILKER (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:WILKER
Last Name:OWEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W FORT WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2432
Mailing Address - Country:US
Mailing Address - Phone:256-249-0943
Mailing Address - Fax:256-249-0943
Practice Address - Street 1:208 W FORT WILLIAM
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150
Practice Address - Country:US
Practice Address - Phone:256-249-0943
Practice Address - Fax:256-249-0943
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1024118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891001550Medicaid
P07204Medicare UPIN
AL891001550Medicaid