MEDICARE: ALTHEA POWELL

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	163WM0705X	Medical-Surgical Registered Nurse	584479	NY

General Provider Information

NPI Number	:	1447784467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALTHEA POWELL

Provider Business Mailing Address
First Line	:	451 FULTON AVE
Second Line	:	APT 216
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-4102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 FULTON AVE
Second Line	:	APT 216
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-4102
Country	:	US
Telephone Number	:	516-424-8615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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Directions to “ ALTHEA POWELL ” Practice Location

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