| Doctor Name: | DEANNA LEA POWELSON |
| NPI Number: | 1548545072 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 2011034113 |
| Business Practice Address: | 100 Medical Plz Suite1201 Lake St Louis, MO - 633671366 |
| Business Phone Number: | 6366255342 |
| Business Fax Number: | |
| Mailing Address: | 211 Evesham W, LAKE ST LOUIS |
| State: | MO |
| Postal Code: | 633672546 |
| Phone Number: | 6367951024 |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2011 |
| NPI Last Update Date: | 10/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2011034113 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |