Healthcare Provider Details

I. General information

NPI: 1346649209
Provider Name (Legal Business Name): APRIL LIANE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: APRIL MARIE LIANE POWELL FNP-C

II. Dates (important events)

Enumeration Date: 08/16/2014
Last Update Date: 08/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WASHINGTON ST EMERGENCY DEPARTMENT
BLOOMINGTON IL
61701-4364
US

IV. Provider business mailing address

2200 E WASHINGTON ST
BLOOMINGTON IL
61701-4364
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-3311
  • Fax:
Mailing address:
  • Phone: 309-662-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: