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NPI Code Detail

MEDICARE: WILLIE POWELL MPA

MEDICARE: WILLIE POWELL MPA
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1356744049
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIE POWELL MPA
Provider Business Mailing Address
First Line : 5220 4TH AVE
Second Line : BROOKLYN
City : BROOKLYN
State : NY
Zip : 11220-1812
Country : US
Telephone Number : 718-360-8169
Fax Number :
Provider Business Practice Location Address
First Line : 5220 4TH AVE
Second Line : BROOKLYN
City : BROOKLYN
State : NY
Zip : 11220-1812
Country : US
Telephone Number : 718-360-8169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2014
Last Update Date : 10/08/2014

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Directions to “ WILLIE POWELL MPA” Practice Location

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