Provider Demographics
NPI:1487942033
Name:POWELL, SASHA MIRANDA (FNP-BC)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:MIRANDA
Last Name:POWELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:MIRANDA
Other - Last Name:PRYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17100 N 600 EAST RD
Mailing Address - Street 2:
Mailing Address - City:FITHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:61844-5104
Mailing Address - Country:US
Mailing Address - Phone:217-202-2438
Mailing Address - Fax:217-202-2438
Practice Address - Street 1:14 W WOODBURY ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-202-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily