Provider Demographics
NPI:1982415311
Name:POWERS, CHARLOTTE GRACE (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:GRACE
Last Name:POWERS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73184 490TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-3784
Mailing Address - Country:US
Mailing Address - Phone:507-841-4518
Mailing Address - Fax:
Practice Address - Street 1:1850 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1190
Practice Address - Country:US
Practice Address - Phone:712-336-6400
Practice Address - Fax:612-725-1245
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1860029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse