MEDICARE: CARMEN POWELL-COOPER BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	22495230	NY

General Provider Information

NPI Number	:	1093107419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN POWELL-COOPER BSN

Provider Business Mailing Address
First Line	:	1665 E 93RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5221
Country	:	US
Telephone Number	:	347-465-0065
Fax Number	:	718-241-0046

Provider Business Practice Location Address
First Line	:	1665 E 93RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5221
Country	:	US
Telephone Number	:	347-465-0065
Fax Number	:	718-241-0046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2015
Last Update Date	:	02/22/2015

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