MEDICARE: JOANNE MATIAS POWELL

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	376G00000X	Nursing Home Administrator	101424	AK

General Provider Information

NPI Number	:	1568133239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE MATIAS POWELL

Provider Business Mailing Address
First Line	:	3720 GALACTICA DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1586
Country	:	US
Telephone Number	:	907-205-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 E 46TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7308
Country	:	US
Telephone Number	:	907-205-0696
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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Directions to “ JOANNE MATIAS POWELL ” Practice Location

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