Provider Demographics
NPI:1043496946
Name:POWERS, GERALDINE CLARE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:CLARE
Last Name:POWERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTER ST.
Mailing Address - Street 2:USAMRIID DIVISION OF MEDICINE
Mailing Address - City:FORT DETRICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-619-0328
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTER ST
Practice Address - Street 2:USAMRIID DIVISION OF MEDICINE
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9211
Practice Address - Country:US
Practice Address - Phone:301-619-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR088736163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse