Healthcare Provider Details

I. General information

NPI: 1740948850
Provider Name (Legal Business Name): DUSTIE SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S ALTON WAY STE A100
CENTENNIAL CO
80112-2207
US

IV. Provider business mailing address

7200 S ALTON WAY STE A100
CENTENNIAL CO
80112-2207
US

V. Phone/Fax

Practice location:
  • Phone: 303-945-7063
  • Fax: 855-568-2494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: