Individual
LIDWINA WANGSADIPURA POWERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5510 SOUTHWEST DR STE 11-12, JONESBORO, AR 72404-8351
(870) 641-4471
(870) 206-7068
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-753
AR
363A00000X
Physician Assistant
PA20529
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
319542212
—
AR
Enumeration date
11/04/2009
Last updated
07/25/2024
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