Provider Demographics
NPI:1649942574
Name:OWENS, ANGELA TRACEY (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:TRACEY
Last Name:OWENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:T
Other - Last Name:DUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1627 SALE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-2153
Mailing Address - Country:US
Mailing Address - Phone:614-316-3794
Mailing Address - Fax:
Practice Address - Street 1:1627 SALE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-2153
Practice Address - Country:US
Practice Address - Phone:614-316-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse