Provider Demographics
NPI:1992143887
Name:POWELL, MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 OLD YORK RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1514
Mailing Address - Country:US
Mailing Address - Phone:215-885-8550
Mailing Address - Fax:215-885-8870
Practice Address - Street 1:8250 OLD YORK RD FL 2
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:215-885-8550
Practice Address - Fax:215-885-8870
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012888363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health