Individual
JEANNA L OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8572
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
26017
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12575
DEAN
WI
05
—
30684400
—
WI
01
—
39080723610
UNITY
WI
01
—
660001190
RAILROAD MEDICARE
WI
01
—
WI0144
JOHN DEERE
WI
Enumeration date
11/15/2005
Last updated
11/01/2012
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