Powell, Diosan Mangubat
Powell, Diosan Mangubat is an sole proprietor health care provider with primary practice located at 346 Stateline Rd W , Southaven MS 38671-1610. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as her primary health care specialty. Powell, Diosan Mangubat can be contacted via phone (662) 510-5353.Contact Information
Primary practice address
346 Stateline Rd W
Southaven MS 38671-1610
Phone: (662) 510-5353
Fax: (662) 510-0409
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Primary Care | 363LP2300X | 21474 | Tennessee |
Profile Details
| NPI number | 1275086902 |
|---|---|
| LBN Legal business name | Powell, Diosan Mangubat |
| Credentials | Family Nurse Practitioner (FNP) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 29th, 2016 |
| Last updated | Dec 26th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275086902 | NPPES |
| Mississippi | MEDICAID | 08778361 |
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