Provider Demographics
NPI:1346406352
Name:POWERFUL, BEVERLY E (RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:E
Last Name:POWERFUL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2027
Mailing Address - Country:US
Mailing Address - Phone:914-667-0300
Mailing Address - Fax:914-667-1407
Practice Address - Street 1:4 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2027
Practice Address - Country:US
Practice Address - Phone:914-667-0300
Practice Address - Fax:914-667-1407
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431008172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker