MEDICARE: MS. CALEY IRENE POWELL B.S.N.,R.N.

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	163WH0200X	Home Health Registered Nurse	64542-030	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609090604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CALEY IRENE POWELL B.S.N.,R.N.

Provider Business Mailing Address
First Line	:	7185 CLARKS POINT RD
Second Line	:
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9761
Country	:	US
Telephone Number	:	920-836-3367
Fax Number	:	920-836-3049

Provider Business Practice Location Address
First Line	:	7185 CLARKS POINT RD
Second Line	:
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9761
Country	:	US
Telephone Number	:	920-836-3367
Fax Number	:	920-836-3049

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/09/2007

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