Provider Demographics
NPI:1619356524
Name:POWELSON, ANN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:POWELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1735 CREEKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3914
Mailing Address - Country:US
Mailing Address - Phone:916-983-3500
Mailing Address - Fax:916-983-8437
Practice Address - Street 1:1735 CREEKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3914
Practice Address - Country:US
Practice Address - Phone:916-983-3500
Practice Address - Fax:916-983-8437
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA162011207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program