Healthcare Provider Details

I. General information

NPI: 1083437792
Provider Name (Legal Business Name): ADWOA POWELL DNP, APN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROAD ST
NEWARK NJ
07102-4531
US

IV. Provider business mailing address

550 BROAD ST
NEWARK NJ
07102-4531
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1161
  • Fax:
Mailing address:
  • Phone: 201-822-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15147700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: