Individual
LACONYA OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2541 SW KENILWORTH ST, PORT SAINT LUCIE, FL 34953-2575
(772) 340-4220
Mailing address
2541 SW KENILWORTH ST, PORT SAINT LUCIE, FL 34953-2575
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5167740
FL
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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