Provider Demographics
NPI:1760917496
Name:POWELL, TRACEE (HHA)
Entity Type:Individual
Prefix:
First Name:TRACEE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SCHOOL ST SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2754
Mailing Address - Country:US
Mailing Address - Phone:202-955-8555
Mailing Address - Fax:202-587-1396
Practice Address - Street 1:501 SCHOOL ST SW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2754
Practice Address - Country:US
Practice Address - Phone:202-955-8555
Practice Address - Fax:202-587-1396
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11440374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide