Healthcare Provider Details

I. General information

NPI: 1598422362
Provider Name (Legal Business Name): TERRI ELLEN POWERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12810 HARFORD RD
HYDES MD
21082-9506
US

IV. Provider business mailing address

12810 HARFORD RD
HYDES MD
21082-9506
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-2594
  • Fax:
Mailing address:
  • Phone: 443-417-5115
  • Fax: 410-505-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR152304
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: