Provider Demographics
NPI:1548545072
Name:POWELSON, DEANNA LEA (DNP, FNP-BC, NP-C)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LEA
Last Name:POWELSON
Suffix:
Gender:F
Credentials:DNP, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EVESHAM W
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2546
Mailing Address - Country:US
Mailing Address - Phone:636-795-1024
Mailing Address - Fax:
Practice Address - Street 1:1475 KISKER RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8781
Practice Address - Country:US
Practice Address - Phone:636-498-7505
Practice Address - Fax:636-498-7477
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011034113363LF0000X
MO2011034114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily