Provider Demographics
NPI:1306469168
Name:POWER, MICHAELLA MARIE
Entity type:Individual
Prefix:
First Name:MICHAELLA
Middle Name:MARIE
Last Name:POWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHAELLA
Other - Middle Name:MARIE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 SE Q ST
Mailing Address - Street 2:APT 31
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144
Mailing Address - Country:US
Mailing Address - Phone:641-572-0749
Mailing Address - Fax:
Practice Address - Street 1:401 SE Q ST
Practice Address - Street 2:APT 31
Practice Address - City:LEON
Practice Address - State:IA
Practice Address - Zip Code:50144
Practice Address - Country:US
Practice Address - Phone:641-572-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider