Provider Demographics
NPI:1598465668
Name:POWERS, STEPHANY
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 THIMBLE SHOALS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4546
Mailing Address - Country:US
Mailing Address - Phone:757-232-9026
Mailing Address - Fax:757-223-6510
Practice Address - Street 1:728 THIMBLE SHOALS BLVD STE C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4546
Practice Address - Country:US
Practice Address - Phone:757-232-9026
Practice Address - Fax:757-223-6510
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1492342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company