Healthcare Provider Details

I. General information

NPI: 1568830396
Provider Name (Legal Business Name): ALYSHA SEWALL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR
COLUMBIA MD
21044-3128
US

IV. Provider business mailing address

10710 CHARTER DR
COLUMBIA MD
21044-3128
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-2212
  • Fax:
Mailing address:
  • Phone: 410-964-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR166141
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: