Healthcare Provider Details

I. General information

NPI: 1235330937
Provider Name (Legal Business Name): MS. ANGELA DIANE SEWEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 AIRPORT BLVD STE 410
MOBILE AL
36606-3658
US

IV. Provider business mailing address

13040 AIRPORT RD
BAY MINETTE AL
36507-3634
US

V. Phone/Fax

Practice location:
  • Phone: 251-470-2554
  • Fax:
Mailing address:
  • Phone: 251-623-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: