Healthcare Provider Details

I. General information

NPI: 1952157885
Provider Name (Legal Business Name): LEILA POWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 8647 UNIT 2381
APO AE
09034
US

IV. Provider business mailing address

CMR 405 BOX 4157
APO AE
09034-0142
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-1009
  • Fax:
Mailing address:
  • Phone: 209-616-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: