Provider Demographics
NPI:1447651153
Name:OWEN, NORMA
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:
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 1:115 S KING AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-4646
Mailing Address - Country:US
Mailing Address - Phone:731-287-9994
Mailing Address - Fax:
Practice Address - Street 1:115 S KING AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-4646
Practice Address - Country:US
Practice Address - Phone:731-287-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator