MEDICARE: AISHA 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	367500000X	Certified Registered Nurse Anesthetist	130196	NY

General Provider Information

NPI Number	:	1588121792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISHA POWELL

Provider Business Mailing Address
First Line	:	2132 WALLACE AVE APT 246
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 WALLACE AVE APT 246
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2504
Country	:	US
Telephone Number	:	917-414-5715
Fax Number	:

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

Provider Enumeration Date	:	02/23/2019
Last Update Date	:	12/03/2019

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Directions to “ AISHA POWELL ” Practice Location

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