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General NPI Number Information
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NPI Number | 1548545072
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Entity Type | Individual
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Provider Name | DEANNA LEA POWELSON DNP, FNP-BC, NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/16/2011
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 1475 KISKER RD
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City | SAINT CHARLES
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State | MO
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Zip | 63304-8781
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Country | US
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Telephone | 636-498-7505
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Fax | 636-498-7477
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Provider Business Mailing Address
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Address Line | 211 EVESHAM W
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2546
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Country | US
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Telephone | 636-795-1024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2011034113
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2011034114
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License Number State | MO
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