MEDICARE: PRINCESS 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	3747P1801X	Personal Care Attendant		MI

General Provider Information

NPI Number	:	1780531095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS POWELL

Provider Business Mailing Address
First Line	:	15642 COUZENS AVE
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-2328
Country	:	US
Telephone Number	:	313-735-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 E OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3402
Country	:	US
Telephone Number	:	313-735-9565
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ PRINCESS POWELL ” Practice Location

Language	Start Address	Practice Location

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