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Individual

MRS. YURI JANEL POWELL-FAULKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-4274
Mailing address
PO BOX 601549, CHARLOTTE, NC 28260-1549
(704) 384-4239
(704) 417-4870

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
22542662
NY
163W00000X
Registered Nurse
R166703
MD
367500000X
Certified Registered Nurse Anesthetist
Primary
76606
NC
367500000X
Certified Registered Nurse Anesthetist
R166703
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
199980701
TX
01
87751U
BLUE CROSS BLUE SHIELD ID
Enumeration date
01/13/2007
Last updated
10/28/2020
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