Provider Demographics
NPI:1295038370
Name:POWELL, TAWANNA M (RRT)
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 VILLA ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-5853
Mailing Address - Country:US
Mailing Address - Phone:252-442-0937
Mailing Address - Fax:
Practice Address - Street 1:204 E ARLINGTON BLVD STE M
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5022
Practice Address - Country:US
Practice Address - Phone:252-321-9300
Practice Address - Fax:252-321-9390
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5958227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered