Healthcare Provider Details

I. General information

NPI: 1669718722
Provider Name (Legal Business Name): RASHAWN LATRESE SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 WILMOT CT
BALTIMORE MD
21202-5417
US

IV. Provider business mailing address

939 WILMOT CT
BALTIMORE MD
21202-5417
US

V. Phone/Fax

Practice location:
  • Phone: 443-414-2372
  • Fax:
Mailing address:
  • Phone: 443-414-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00105357
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: