Provider Demographics
NPI:1871278671
Name:POWELL, CLARA ADOME
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:ADOME
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 SHARE AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6527
Mailing Address - Country:US
Mailing Address - Phone:734-444-8428
Mailing Address - Fax:
Practice Address - Street 1:1432 SHARE AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6527
Practice Address - Country:US
Practice Address - Phone:734-444-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care