Healthcare Provider Details

I. General information

NPI: 1194180356
Provider Name (Legal Business Name): BRITTANY ANN SEWELL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 W 95TH ST STE 100
OAK LAWN IL
60453-2394
US

IV. Provider business mailing address

16341 LAKESIDE DR
LOCKPORT IL
60441-7030
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-1601
  • Fax: 708-636-1825
Mailing address:
  • Phone: 708-297-6052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041376555
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014157
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: