Provider Demographics
NPI:1164457743
Name:POWERS, PRISCILLA JANE (APRN)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:JANE
Last Name:POWERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341-9648
Mailing Address - Country:US
Mailing Address - Phone:808-343-0397
Mailing Address - Fax:
Practice Address - Street 1:2002 SE MARINE SCIENCE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5229
Practice Address - Country:US
Practice Address - Phone:541-867-8821
Practice Address - Fax:541-867-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347249-4405363LF0000X
OR201250013NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily