Provider Demographics
NPI:1265499545
Name:POWELL, JUNE MAXINE (MS, RD, CNSD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:MAXINE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS, RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4002
Mailing Address - Country:US
Mailing Address - Phone:540-387-1776
Mailing Address - Fax:
Practice Address - Street 1:1118 TAMARACK LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4002
Practice Address - Country:US
Practice Address - Phone:540-387-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal