Provider Demographics
NPI:1316531528
Name:POWELL, CARLEEN O (LPN)
Entity type:Individual
Prefix:
First Name:CARLEEN
Middle Name:O
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PLAINFIELD AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2141
Mailing Address - Country:US
Mailing Address - Phone:347-837-0474
Mailing Address - Fax:
Practice Address - Street 1:60 PLAINFIELD AVE APT 6
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2141
Practice Address - Country:US
Practice Address - Phone:347-837-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse