Provider Demographics
NPI:1255197794
Name:POWERS, LUCINDA PELKEY
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:PELKEY
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9251 W COUNTRY CLUB TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4263
Mailing Address - Country:US
Mailing Address - Phone:239-834-7867
Mailing Address - Fax:
Practice Address - Street 1:9251 W COUNTRY CLUB TRL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4263
Practice Address - Country:US
Practice Address - Phone:239-834-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider