Healthcare Provider Details

I. General information

NPI: 1265499545
Provider Name (Legal Business Name): JUNE MAXINE POWELL M.S., R.D., C.N.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 TAMARACK LN
SALEM VA
24153-4002
US

IV. Provider business mailing address

1118 TAMARACK LN
SALEM VA
24153-4002
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-1776
  • Fax:
Mailing address:
  • Phone: 540-387-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: