Individual
WENDY T OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
39 DONELSON ST, FORT BRAGG, NC 28307-2024
(910) 920-2047
Mailing address
39 DONELSON ST, FORT BRAGG, NC 28307-2024
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085-002498
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002498
IL STATE LIC
IL
Enumeration date
10/11/2006
Last updated
07/16/2009
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