Healthcare Provider Details

I. General information

NPI: 1568660819
Provider Name (Legal Business Name): BONNIE J POWERS MT(ASCP)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY STE. 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

539 AZALEA DR #9
DESTIN FL
32541-2369
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax:
Mailing address:
  • Phone: 850-240-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberSU 26806
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: