Healthcare Provider Details

I. General information

NPI: 1861591869
Provider Name (Legal Business Name): MARY ELLEN POWRIE RNC BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1558 LAKEVIEW DRIVE
SEBRING FL
33870
US

IV. Provider business mailing address

200 AVENUE F NE
WINTER HAVEN FL
33881
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-5179
  • Fax: 863-291-6084
Mailing address:
  • Phone: 863-293-1121
  • Fax: 863-291-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN813602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: