Healthcare Provider Details

I. General information

NPI: 1720406713
Provider Name (Legal Business Name): ALEC J'DAN POWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S. HUDSON STE #6
SILVER CITY NM
88061
US

IV. Provider business mailing address

1320 S. SOLANO
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-4412
  • Fax: 575-534-1170
Mailing address:
  • Phone: 575-527-7900
  • Fax: 575-571-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN-78019
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: