Provider Demographics
NPI:1962740050
Name:POWELL, NADINE
Entity type:Individual
Prefix:MRS
First Name:NADINE
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 1:52 PROMINENT BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-3306
Mailing Address - Country:US
Mailing Address - Phone:702-526-0527
Mailing Address - Fax:702-577-0038
Practice Address - Street 1:52 PROMINENT BLUFF CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-3306
Practice Address - Country:US
Practice Address - Phone:702-526-0527
Practice Address - Fax:702-577-0038
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121132212103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst