1619923505 NPI number — MS. MARSHELLE LYNN POWELL P.A.-C

Table of content: MS. MARSHELLE LYNN POWELL P.A.-C (NPI 1619923505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619923505 NPI number — MS. MARSHELLE LYNN POWELL P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
MARSHELLE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619923505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28408-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-392-2525
Provider Business Mailing Address Fax Number:
910-392-2525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 S 16TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-6491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-452-8633
Provider Business Practice Location Address Fax Number:
910-452-8569
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0010-2223 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com