Provider Demographics
NPI:1437119161
Name:POWELL, ELMIRA (PA)
Entity Type:Individual
Prefix:
First Name:ELMIRA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12860
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4019
Mailing Address - Country:US
Mailing Address - Phone:919-334-0123
Mailing Address - Fax:336-286-6566
Practice Address - Street 1:510 N ELAM AVE STE 303
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1142
Practice Address - Country:US
Practice Address - Phone:336-974-4437
Practice Address - Fax:336-365-5790
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100940363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970026793Medicare PIN
NC2744922EMedicare PIN
NCS48794Medicare UPIN
NC2744922BMedicare PIN