Provider Demographics
NPI:1689206591
Name:POWELL, VINCENT LAMARR SR (LPN)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:LAMARR
Last Name:POWELL
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 TRIVUE CIR APT C
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1762
Mailing Address - Country:US
Mailing Address - Phone:216-322-9293
Mailing Address - Fax:
Practice Address - Street 1:9409 TRIVUE CIR APT C
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-1762
Practice Address - Country:US
Practice Address - Phone:216-322-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN124866164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse