Provider Demographics
NPI:1558327643
Name:POWELL, ANN R (CNM)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:R
Last Name:POWELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:DOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:ATTN KELLY STEELE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:130 EMPIRE DR
Practice Address - Street 2:EMPIRE DRIVE HEALTH CENTER
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-668-6170
Practice Address - Fax:716-656-4074
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF0001211367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159708CQOtherPREFERRED CARE #
NYP00325668OtherMEDICARE RAILROAD #
NY000560350007OtherHEALTH NOW BCBS #
NY040426001914OtherFIDELIS#
NY9513203OtherIHA LEGACY#
NY159708CQOtherPREFERRED CARE #
NY9513203OtherIHA LEGACY#