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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