Provider Demographics
NPI:1518402189
Name:POWELL-GONZALEZ, MEGAN GABRIELLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:GABRIELLE
Last Name:POWELL-GONZALEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S MAIN ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186-9613
Mailing Address - Country:US
Mailing Address - Phone:518-727-8094
Mailing Address - Fax:
Practice Address - Street 1:1 COMPUTER DR S
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1655
Practice Address - Country:US
Practice Address - Phone:518-459-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318009-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse