Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 130089 | WI |
N | 363LN0000X | Nurse Practitioner - Neonatal | 5428 | WI |
NPI | 1174958045 |
---|---|
Provider Name | Renee S Powell |
First Address | Eau Claire, WI 54702-1510 |
Second Address | La Crosse, WI 54601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 15/09/2020 |