1902944127 NPI number — DR. NANCY LOUISA POWERS RN, NP, DNSC.

Table of content: CARA CAUDLE (NPI 1316715923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902944127 NPI number — DR. NANCY LOUISA POWERS RN, NP, DNSC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWERS
Provider First Name:
NANCY
Provider Middle Name:
LOUISA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RN, NP, DNSC.
Provider Gender Code:
F

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:
1902944127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RHODODENDRON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97049-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-228-3081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5331 SW MACADAM AVENUE
Provider Second Line Business Practice Location Address:
SUITE 397
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-228-3081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  087006752N1 FNP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 087006752N1 . This is a "STATE LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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