Provider Demographics
NPI:1649523945
Name:POWELL, JANA (RN)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-3103
Mailing Address - Country:US
Mailing Address - Phone:623-691-4215
Mailing Address - Fax:623-691-4220
Practice Address - Street 1:3600 N 47TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3103
Practice Address - Country:US
Practice Address - Phone:623-691-4215
Practice Address - Fax:623-691-4220
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN166267390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program