MEDICARE: POWERFUL EXPRESSIONS LLC

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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1659039808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWERFUL EXPRESSIONS LLC

Provider Business Mailing Address
First Line	:	739 THIMBLE SHOALS BLVD STE 1011F
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-3601
Country	:	US
Telephone Number	:	757-343-4479
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 THIMBLE SHOALS BLVD STE 1011F
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-3601
Country	:	US
Telephone Number	:	757-343-4479
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TAWAN ALISA MANER
Credential	:
Telephone Number	:	757-343-4479

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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