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Organization
HOUSE OF LIFE FAMILY PRACTICE PLLC
Active
Organization
HOUSE OF LIFE FAMILY PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELE DENISE POWELL DO (MEMBER/MANAGER)
(336) 765-3430
Entity
Organization
Contact information
Practice address
1800 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4014
(336) 765-3430
(336) 765-3429
Mailing address
1800 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4014
(336) 765-3430
(336) 765-3429
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033392774
INDIVIDUAL NPI
NC
01
—
131Y7
BLUE CROSS BS
—
05
—
89131Y7
—
NC
Enumeration date
03/10/2006
Last updated
04/20/2008
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