1831332675 NPI number — TANA M POWELL

Table of content: KATIE LINDSEY (NPI 1821354283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831332675 NPI number — TANA M POWELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TANA M POWELL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831332675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4741 WICKFORD DR W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVANIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43560-3357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-290-4741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4741 WICKFORD DR W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-290-4741
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
TANA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
NURSE
Authorized Official Telephone Number:
419-290-4741

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  PN.134008-IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)