MEDICARE: NICOLE POWERS

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	C017043	NC
3	1041C0700X	Clinical Social Worker	9713-123	WI

General Provider Information

NPI Number	:	1851789150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE POWERS

Provider Business Mailing Address
First Line	:	3264 N FRATNEY ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2241
Country	:	US
Telephone Number	:	414-322-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	3264 N FRATNEY ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2241
Country	:	US
Telephone Number	:	414-322-3284
Fax Number	:

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

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	03/17/2025

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Directions to “ NICOLE POWERS ” Practice Location

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