Provider Demographics
NPI:1265030217
Name:POWELL, ALISHA ROSE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:ROSE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 CLIFFTOP DR APT 84
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-8893
Mailing Address - Country:US
Mailing Address - Phone:304-490-9945
Mailing Address - Fax:
Practice Address - Street 1:216 CLIFFTOP DR APT 84
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-8893
Practice Address - Country:US
Practice Address - Phone:304-490-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant