Basic Information
| Provider Information | |||||||||
| NPI: | 1841803087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | TESS | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EATON RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488271952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179994500 | ||||||||
| FaxNumber: | 5179994510 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EATON RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488271952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179994500 | ||||||||
| FaxNumber: | 5179994510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2020 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704269924 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.