Individual
GLENN OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
392 162ND ST, HAMMOND, WI 54015-5222
(612) 598-3149
Mailing address
392 162ND ST, HAMMOND, WI 54015-5222
(612) 598-3149
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
320057
WI
Other
Enumeration date
01/07/2016
Last updated
01/07/2016
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