Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 312729 | OH |
NPI | 1013149939 |
---|---|
Provider Name | Traci A Powell |
First Address | Chillicothe, OH 45601-0188 |
Second Address | Chillicothe, OH 45601-7833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3016042 | (05) | OH |