Provider Demographics
NPI:1093829715
Name:POWELL, LAURIE L (CMW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:CMW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:L
Other - Last Name:POWELL-ACHENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMW
Mailing Address - Street 1:129 ONEIDA VALLEY RD STE 211
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2252
Mailing Address - Country:US
Mailing Address - Phone:844-765-2845
Mailing Address - Fax:724-431-1668
Practice Address - Street 1:129 ONEIDA VALLEY RD STE 211
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2252
Practice Address - Country:US
Practice Address - Phone:844-765-2845
Practice Address - Fax:724-431-1668
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008506L367A00000X
PAMW00856L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife