Healthcare Provider Details

I. General information

NPI: 1538993969
Provider Name (Legal Business Name): ANDREA E POWELL MSN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA E MOWRER

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2011
  • Fax:
Mailing address:
  • Phone: 559-676-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number95031892
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number95031892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: