Provider Information for 1588999155
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FAYE ANTIONETTE POWELL
Sex: Female
NPI: 1588999155
Last Updated: 2009-10-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1588999155 | ||||||||
| Enumeration Date | 2009-10-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8023 S WHEELING AVE APT D TULSA, OK 74136-5233 United States Phone: 912-604-1770 | Fax: | ||||||||
| Primary Practice Address | 423 W WILL ROGERS BLVD CLAREMORE, OK 74017-6820 United States Phone: 918-342-2080 | Fax:918-342-0075 | ||||||||
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