Healthcare Provider Details

I. General information

NPI: 1447323225
Provider Name (Legal Business Name): JOANNE LEE POWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 COLUMBIA RD
DORCHESTER MA
02125-2424
US

IV. Provider business mailing address

12 JEROME ST
DORCHESTER MA
02125-2021
US

V. Phone/Fax

Practice location:
  • Phone: 617-287-8000
  • Fax: 617-287-1500
Mailing address:
  • Phone: 617-288-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number105761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: