Provider Demographics
NPI:1598422362
Name:POWERS, TERRI ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:ELLEN
Last Name:POWERS
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 1:12810 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:HYDES
Mailing Address - State:MD
Mailing Address - Zip Code:21082-9506
Mailing Address - Country:US
Mailing Address - Phone:443-417-5115
Mailing Address - Fax:410-505-2493
Practice Address - Street 1:12810 HARFORD RD
Practice Address - Street 2:
Practice Address - City:HYDES
Practice Address - State:MD
Practice Address - Zip Code:21082-9506
Practice Address - Country:US
Practice Address - Phone:410-724-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR152304163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management