Healthcare Provider Details

I. General information

NPI: 1528216942
Provider Name (Legal Business Name): FABIOLA SEWELL CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SIMPSON AVE
ELKHART IN
46516-4671
US

IV. Provider business mailing address

135 RIVERVIEW AVENUE
ELKHART IN
46516
US

V. Phone/Fax

Practice location:
  • Phone: 574-293-4052
  • Fax:
Mailing address:
  • Phone: 574-333-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: