Individual
OWEN ADOLPHSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
602 JACKSON ST, PETOSKEY, MI 49770-2220
(231) 348-2795
(231) 348-2031
Mailing address
602 JACKSON ST, PETOSKEY, MI 49770-2220
(231) 348-2795
(231) 348-2031
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN757422
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
4704351318
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
RN757422
PA
Other
Enumeration date
07/29/2024
Last updated
05/06/2026
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