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Individual

WINSOME POWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2394 SW KENT CIR, PORT SAINT LUCIE, FL 34953-5707
(772) 361-5648
Mailing address
2394 SW KENT CIR, PORT SAINT LUCIE, FL 34953-5707
(772) 361-5648

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
347C00000X
Private Vehicle
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
26-4073370
FL
Enumeration date
01/20/2009
Last updated
01/20/2009
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