Laci Jade Powell, STNA
Individual provider Active NPI Nurse's Aide · Malta, OH
NPI 1760622914 · NPPES record last updated Mar 1, 2009
Key facts
- NPI
- 1760622914
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse's Aide 376K00000X
- License
- 400767990608 (OH)
- Practice address
- 4458 W Poplar Ridge Rd NW
Malta, OH 43758-9127 - Phone
- (740) 962-6169
- NPI assigned
- Mar 1, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 400767990608 | OH | MD | Nurse's Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 400767990608 | OH | Yes |
Addresses
Primary practice location
4458 W Poplar Ridge Rd NW
Malta, OH 43758-9127
Mailing address
4458 W Poplar Ridge Rd NW
Malta, OH 43758-9127
Phone (740) 962-6169
Other providers in Malta, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.