Individual
LYDELL POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
1897 HOLLYHOCK CIR, FARMINGTON, NM 87401-4701
(505) 360-7709
Mailing address
1897 HOLLYHOCK CIR, FARMINGTON, NM 87401-4701
(505) 360-7709
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
NM
Other
Enumeration date
11/22/2011
Last updated
04/16/2021
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