Provider Demographics
NPI:1649501016
Name:POWELL, LAUREL KAROLINA (LMT)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:KAROLINA
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 NW 23RD AVE
Mailing Address - Street 2:#6
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3003
Mailing Address - Country:US
Mailing Address - Phone:503-799-5226
Mailing Address - Fax:
Practice Address - Street 1:1536 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2618
Practice Address - Country:US
Practice Address - Phone:503-799-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR116962083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine