Provider Demographics
NPI:1386465227
Name:POWELL-CORK, JADYN
Entity type:Individual
Prefix:
First Name:JADYN
Middle Name:
Last Name:POWELL-CORK
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 1:18336 MARSHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3318
Mailing Address - Country:US
Mailing Address - Phone:219-427-8085
Mailing Address - Fax:
Practice Address - Street 1:18336 MARSHFIELD AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3318
Practice Address - Country:US
Practice Address - Phone:219-427-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program