Healthcare Provider Details

I. General information

NPI: 1902366727
Provider Name (Legal Business Name): JANICE M POWERS PHD, RN, CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

422 SAVANNAH LN
WESTFIELD IN
46074-9445
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-7761
  • Fax:
Mailing address:
  • Phone: 317-850-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number28096551A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: