Healthcare Provider Details

I. General information

NPI: 1568133239
Provider Name (Legal Business Name): JOANNE MATIAS POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 46TH AVE
ANCHORAGE AK
99503-7308
US

IV. Provider business mailing address

3720 GALACTICA DR
ANCHORAGE AK
99517-1586
US

V. Phone/Fax

Practice location:
  • Phone: 907-205-0696
  • Fax:
Mailing address:
  • Phone: 907-205-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number101424
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: