Healthcare Provider Details

I. General information

NPI: 1366957896
Provider Name (Legal Business Name): SARAH-ELIZABETH R SEWAK NICHOLS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 LORNA RD STE 240
BIRMINGHAM AL
35244-3003
US

IV. Provider business mailing address

3825 LORNA RD STE 240
BIRMINGHAM AL
35244-3003
US

V. Phone/Fax

Practice location:
  • Phone: 205-988-3733
  • Fax: 205-985-4431
Mailing address:
  • Phone: 205-988-3733
  • Fax: 205-985-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.1286
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: