Healthcare Provider Details

I. General information

NPI: 1447363635
Provider Name (Legal Business Name): PHILIP JOHN POWERS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 38TH ST
COLUMBUS NE
68601-1664
US

IV. Provider business mailing address

PO BOX 1800
COLUMBUS NE
68602-1800
US

V. Phone/Fax

Practice location:
  • Phone: 402-564-7118
  • Fax: 402-562-3378
Mailing address:
  • Phone: 402-564-7118
  • Fax: 402-562-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100529
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: