Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MD33940 | DC |
NPI | 1073688487 |
---|---|
Provider Name | Dr. Clydette Linda Powell |
First Address | Arlington, VA 22201-5710 |
Second Address | Washington, DC 20010-2978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |