1336101971 NPI number — KAREN POWELL CRNP

Table of content: KAREN POWELL CRNP (NPI 1336101971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336101971 NPI number — KAREN POWELL CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1336101971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 E BROWN ST
Provider Second Line Business Mailing Address:
POCONO HEALTHCARE MGMT. - PROFESSIONAL BLDG.
Provider Business Mailing Address City Name:
E STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18301-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-420-4969
Provider Business Mailing Address Fax Number:
570-476-3754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COMMUNITY DR
Provider Second Line Business Practice Location Address:
POCONO OBSTETRICS AND GYNECOLOGY. SUITE 205
Provider Business Practice Location Address City Name:
TOBYHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18466-8985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-895-4331
Provider Business Practice Location Address Fax Number:
570-895-4332
Provider Enumeration Date:
04/06/2006

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: 363LX0001X , with the licence number:  SP001223G , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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