Healthcare Provider Details

I. General information

NPI: 1174337737
Provider Name (Legal Business Name): HEATHER ANN SEWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST
EVERETT MA
02149-5066
US

IV. Provider business mailing address

159 COLUMBIA ST
MALDEN MA
02148-1740
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2264270
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2264270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: