Healthcare Provider Details

I. General information

NPI: 1346720067
Provider Name (Legal Business Name): ANITA POWELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MILUK DR
COOS BAY OR
97420-7728
US

IV. Provider business mailing address

1100 9TH AVE M4-PFS
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 541-888-9494
  • Fax:
Mailing address:
  • Phone: 206-515-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPQ229510
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: