Provider Demographics
NPI:1831332675
Name:TANA M POWELL
Entity type:Organization
Organization Name:TANA M POWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:TANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:419-290-4741
Mailing Address - Street 1:4741 WICKFORD DR W
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3357
Mailing Address - Country:US
Mailing Address - Phone:419-290-4741
Mailing Address - Fax:
Practice Address - Street 1:4741 WICKFORD DR W
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3357
Practice Address - Country:US
Practice Address - Phone:419-290-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.134008-IV305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service