Provider Demographics
NPI:1902423841
Name:POWELL, NICOLE REINECKE (DNP, FNP-BC, RNC-OB)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:REINECKE
Last Name:POWELL
Suffix:
Gender:F
Credentials:DNP, FNP-BC, RNC-OB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1786
Mailing Address - Country:US
Mailing Address - Phone:770-867-6633
Mailing Address - Fax:
Practice Address - Street 1:133 W ATHENS ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1786
Practice Address - Country:US
Practice Address - Phone:770-867-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily