MEDICARE: SARAH-ELIZABETH R SEWAK NICHOLS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.1286	AL

General Provider Information

NPI Number	:	1366957896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH-ELIZABETH R SEWAK NICHOLS PA

Provider Business Mailing Address
First Line	:	3825 LORNA RD STE 240
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-3003
Country	:	US
Telephone Number	:	205-988-3733
Fax Number	:	205-985-4431

Provider Business Practice Location Address
First Line	:	3825 LORNA RD STE 240
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-3003
Country	:	US
Telephone Number	:	205-988-3733
Fax Number	:	205-985-4431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2018

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