Provider Demographics
NPI:1912121286
Name:POWELL, GLENDA DARLENE
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:DARLENE
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 1:857 THOMPSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:OTWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45657-9086
Mailing Address - Country:US
Mailing Address - Phone:740-372-0115
Mailing Address - Fax:740-965-8576
Practice Address - Street 1:857 THOMPSON HILL RD
Practice Address - Street 2:
Practice Address - City:OTWAY
Practice Address - State:OH
Practice Address - Zip Code:45657-9086
Practice Address - Country:US
Practice Address - Phone:740-372-0115
Practice Address - Fax:740-965-8576
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2518921Medicaid