MEDICARE: P.O.W.E.R. WELLNESS AND FAMILY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1306799333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P.O.W.E.R. WELLNESS AND FAMILY CENTER, LLC

Provider Business Mailing Address
First Line	:	735 E WALNUT ST STE 4
Second Line	:	SUITE 4
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4062
Country	:	US
Telephone Number	:	274-207-4257
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 E WALNUT ST STE 4
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4062
Country	:	US
Telephone Number	:	274-207-4257
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/OWNER
Name	:	LAMECIA DIANE PALMER
Credential	:
Telephone Number	:	312-607-1605

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	03/23/2026

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