Provider Demographics
NPI:1689991887
Name:POWELL, MARK H (MSN, RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:POWELL
Suffix:
Gender:M
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 THUNDERBOLT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7100
Mailing Address - Country:US
Mailing Address - Phone:928-486-2910
Mailing Address - Fax:928-415-4291
Practice Address - Street 1:675 THUNDERBOLT AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-7100
Practice Address - Country:US
Practice Address - Phone:928-486-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN077937163W00000X, 163WA2000X, 163WP0808X, 163WA2000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health