Individual
ROBERT POWELL
Active
Individual
ROBERT POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
160.004470
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36-34784281
FEIN
IL
Enumeration date
06/20/2011
Last updated
06/20/2011
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