Provider Demographics
NPI:1669980066
Name:POWELL, MICHELE (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:MICHELE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-325-4321
Mailing Address - Fax:
Practice Address - Street 1:2265 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3331
Practice Address - Country:US
Practice Address - Phone:503-338-4050
Practice Address - Fax:503-338-4051
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202001639NP-PP363L00000X
AL1-065492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner