Provider Demographics
NPI:1659039808
Name:POWERFUL EXPRESSIONS LLC
Entity Type:Organization
Organization Name:POWERFUL EXPRESSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAWAN
Authorized Official - Middle Name:ALISA
Authorized Official - Last Name:MANER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-343-4479
Mailing Address - Street 1:739 THIMBLE SHOALS BLVD STE 1011F
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3601
Mailing Address - Country:US
Mailing Address - Phone:757-343-4479
Mailing Address - Fax:
Practice Address - Street 1:739 THIMBLE SHOALS BLVD STE 1011F
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3601
Practice Address - Country:US
Practice Address - Phone:757-343-4479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health