Healthcare Provider Details

I. General information

NPI: 1164689410
Provider Name (Legal Business Name): LATOYA S. SEWELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATOYA F. STUCKEY

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 300-1274
COLUMBIA MD
21045-3259
US

IV. Provider business mailing address

5457 TWIN KNOLLS RD STE 300-1274
COLUMBIA MD
21045-3259
US

V. Phone/Fax

Practice location:
  • Phone: 443-459-1624
  • Fax: 866-485-2859
Mailing address:
  • Phone: 443-459-1624
  • Fax: 866-485-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR157845
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR157845
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: