Healthcare Provider Details

I. General information

NPI: 1821375361
Provider Name (Legal Business Name): TODD ANDREW POWELL AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 PROSPECT PL NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

7001 PROSPECT PL NE
ALBUQUERQUE NM
87110-4311
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-0036
  • Fax: 505-764-0446
Mailing address:
  • Phone: 505-764-0036
  • Fax: 505-764-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: