Individual
MISS LACI JADE POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
4458 W POPLAR RIDGE RD NW, MALTA, OH 43758-9127
(740) 962-6169
Mailing address
4458 W POPLAR RIDGE RD NW, MALTA, OH 43758-9127
(740) 962-6169
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
400767990608
OH
Other
Enumeration date
03/01/2009
Last updated
03/01/2009
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