Provider Demographics
NPI:1639824915
Name:POWERS, MANDI (CHW)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0132
Mailing Address - Country:US
Mailing Address - Phone:971-373-4165
Mailing Address - Fax:
Practice Address - Street 1:24934 FIR GROVE LN
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:OR
Practice Address - Zip Code:97437-9751
Practice Address - Country:US
Practice Address - Phone:541-234-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker