Individual provider · NPI-1

Shanette Bruce Owen

Family Medicine · Kennewick, WA

NPI number1629430228
StatusActive
Last updated in NPPESSep 22, 2021

Details

NPI
1629430228
Entity type
Individual (NPI-1)
Name
Shanette Bruce Owen
Sex
Female
Sole proprietor
No
Enumeration date
Mar 23, 2016
Certification date
Sep 22, 2021
Last updated
Sep 22, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineOL60849496WAYes

Other names

  • Shanette Jean Owen (Former Name)

Practice location

6351 W Rio Grande Ave
Kennewick, WA 99336-7634

Phone 509-543-9280 · Fax 509-579-5915

Mailing address

6351 W Rio Grande Ave
Kennewick, WA 99336-7634

Phone 509-543-9280 · Fax 509-579-5915

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