Provider Demographics
NPI:1770770596
Name:POWELL, YVETTE ELINOR (DOM/L AC, LMT)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:ELINOR
Last Name:POWELL
Suffix:
Gender:F
Credentials:DOM/L AC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E PALACE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2256
Mailing Address - Country:US
Mailing Address - Phone:505-986-8149
Mailing Address - Fax:
Practice Address - Street 1:855 E PALACE AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2256
Practice Address - Country:US
Practice Address - Phone:505-986-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM938171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist