Provider Demographics
NPI:1861192411
Name:OWENS, CHRISTOPHER LEE
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:LEE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 JADENS WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2470
Mailing Address - Country:US
Mailing Address - Phone:757-769-9237
Mailing Address - Fax:
Practice Address - Street 1:464 INVESTORS PL STE 102C
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1167
Practice Address - Country:US
Practice Address - Phone:757-945-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA457803011253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA457803011Medicaid