Provider Demographics
NPI:1902501455
Name:POWELL, CHRISTINA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LISTER DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2209
Mailing Address - Country:US
Mailing Address - Phone:570-218-2331
Mailing Address - Fax:
Practice Address - Street 1:41 PAGE PARK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:NY
Practice Address - Zip Code:12603-7500
Practice Address - Country:US
Practice Address - Phone:845-486-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse