Healthcare Provider Details

I. General information

NPI: 1174938641
Provider Name (Legal Business Name): ELIZABETH JOANNE POUWELS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CHRISTIAN RIDGE RD
ELLSWORTH ME
04605-3210
US

IV. Provider business mailing address

415 WATER ST
ELLSWORTH ME
04605-2116
US

V. Phone/Fax

Practice location:
  • Phone: 207-610-8025
  • Fax:
Mailing address:
  • Phone: 207-667-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN59727
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: