Healthcare Provider Details

I. General information

NPI: 1952392656
Provider Name (Legal Business Name): CATHERINE POWELL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 W TAFT RD SUITE 208
LIVERPOOL NY
13088-2800
US

IV. Provider business mailing address

792 N MAIN ST SUITE 100A
NORTH SYRACUSE NY
13212-1644
US

V. Phone/Fax

Practice location:
  • Phone: 315-451-2261
  • Fax: 315-451-3162
Mailing address:
  • Phone: 315-423-9722
  • Fax: 315-423-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301370
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: