Healthcare Provider Details

I. General information

NPI: 1669908364
Provider Name (Legal Business Name): HOLLIE ANN POWER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date: 12/06/2017
Reactivation Date: 12/13/2017

III. Provider practice location address

660 SOUTH EUCLID AVENUE, 1150 NW TOWER, CAMPUS BX 8238 DIVISION OF PLASTIC & RECONSTRUCTIVE SURGERY, WASHINGTO
ST LOUIS MO
63110
US

IV. Provider business mailing address

660 SOUTH EUCLID AVENUE, 1150 NW TOWER, CAMPUS BOX 8238 DIVISION OF PLASTIC & RECONSTRUCTIVE SURGERY
ST. LOUIS MO
63108
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-0541
  • Fax:
Mailing address:
  • Phone: 314-747-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2017005306
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number2017005306
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: