Provider Demographics
NPI:1780251199
Name:POWELL, ALICIA (ND)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:CONYNGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18219-0635
Mailing Address - Country:US
Mailing Address - Phone:707-382-2962
Mailing Address - Fax:
Practice Address - Street 1:642 STATE ROUTE 93 HWY STE 32
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-3127
Practice Address - Country:US
Practice Address - Phone:570-582-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134079175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath