Healthcare Provider Details

I. General information

NPI: 1699450478
Provider Name (Legal Business Name): COURTNEY RANIER POWELL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

350 LAGUNA HONDA BLVD APT 2
SAN FRANCISCO CA
94116-1412
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95085227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: