Provider Demographics
NPI:1962884379
Name:POWELL, NORMAN DALE SR
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:DALE
Last Name:POWELL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WEBSTER ST.
Mailing Address - Street 2:APT. 2
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-727-6800
Mailing Address - Fax:
Practice Address - Street 1:43 WEBSTER ST.
Practice Address - Street 2:APT. 2
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-349-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide