Provider Demographics
NPI:1851412126
Name:POWELL, LINDA PAULENE (LPN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:PAULENE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAULENE
Other - Middle Name:L
Other - Last Name:OPPY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4753 POPLAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8745
Mailing Address - Country:US
Mailing Address - Phone:740-574-8894
Mailing Address - Fax:740-574-8894
Practice Address - Street 1:4753 POPLAR FORK RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8745
Practice Address - Country:US
Practice Address - Phone:740-574-8894
Practice Address - Fax:740-574-8894
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH057663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2096440Medicaid