Provider Demographics
NPI:1124842927
Name:POWELL, CASANDRA
Entity type:Individual
Prefix:
First Name:CASANDRA
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 1:138 GREAT TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8073
Mailing Address - Country:US
Mailing Address - Phone:678-900-0397
Mailing Address - Fax:
Practice Address - Street 1:138 GREAT TRAIL ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8073
Practice Address - Country:US
Practice Address - Phone:678-900-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals