Healthcare Provider Details

I. General information

NPI: 1679867675
Provider Name (Legal Business Name): PAUL M POWELL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W PRINCE RD
TUCSON AZ
85705-3114
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-887-0800
  • Fax: 520-887-1393
Mailing address:
  • Phone: 520-682-4560
  • Fax: 520-682-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3996
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: