Provider Demographics
NPI:1164872693
Name:POWELL, CHRISTINA D (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:D
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SMALLEY BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6210
Mailing Address - Country:US
Mailing Address - Phone:513-485-6057
Mailing Address - Fax:
Practice Address - Street 1:2052 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4746
Practice Address - Country:US
Practice Address - Phone:513-863-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.147922-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse