=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861442915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH P POWELL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 04/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 TOWER RD SUITE 120
-----------------------------------------------------
City | DAKOTA DUNES
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57049-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-217-4320
-----------------------------------------------------
Fax | 605-217-2948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 SPANISH BAY
-----------------------------------------------------
City | DAKOTA DUNES
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57049-5447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-389-4155
-----------------------------------------------------
Fax | 605-217-2948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 36300
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | ME86858
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 6016
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------